- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/171837/case-manager%2c-rn utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- Prime Healthcare (Ontario, CA)
- … Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according to ... A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management ...a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA) certificate upon hire… more
- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/157925/case-manager-rn%2c-- utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to the… more
- Prime Healthcare (Montclair, CA)
- …Us! (https://careers-primehealthcare.icims.com/jobs/175009/case-manager-%28rn%29 utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- Molina Healthcare (Long Beach, CA)
- …Experience:** + Minimum 3 years Managed Care experience + Minimum 3 years Utilization Management Review experience **Required Licensure or Certification:** ... **Job Description** **Job Summary** The Clinical Correspondence Review Nurse is responsible for performing...standing **Preferred Qualifications:** + 5+ years of experience in Utilization Management in Managed Care setting +… more
- ERP International (Camp Pendleton, CA)
- **Overview** ERP International, LLC is seeking a ** Nurse Practitioner** for a full-time position supporting the **Pain Management Clinic** at **Camp Pendleton, ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- Elevance Health (Costa Mesa, CA)
- …**How you will make an impact:** + Develops, maintains, and enhances the claims review process. + Assists management with developing unit goals, policies, and ... Nurse Audit Lead - Carelon Payment Integrity **Location:**...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment… more
- Pipeline Health System, LLC (Gardena, CA)
- …performs a wide variety of tasks and functions. These include utilization review , discharge planning, care coordination and variance management to assure the ... Case Manager Registered Nurse RN - Per Diem 8-Hour Day Shift...team to ensure coordination of patient care and wise utilization of resources. + Documents case management … more
- Pipeline Health System, LLC (Gardena, CA)
- …performs a wide variety of tasks and functions. These include utilization review , discharge planning, care coordination and variance management to assure the ... team to ensure coordination of patient care and wise utilization of resources. + Documents case management ...interdisciplinary team. Communicates expected discharges to the unit charge nurse , patient unit and family. + Identifies patients at… more
- Molina Healthcare (Long Beach, CA)
- …hour shift from then on._** **_Previous experience with Emergency Room Utilization Management / Utilization Review is required for this role. Experience ... **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_PERMANENT SHIFT WILL BE...or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current… more
- Molina Healthcare (Long Beach, CA)
- …are seeking a LVN (Licensed Vocational Nurse ) with experience in Prior Authorizations, Utilization Review / Utilization Management and knowledge of ... 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association** Active,… more
- HCA Healthcare (Riverside, CA)
- …+ Registered Nurse (RN) with current California license required, Case Management Certification or utilization review preferred + Associate's Degree ... you passionate about delivering patient-centered care?** Submit your application for Case Management Coordinator position and spend more time at the bedside with the… more
- Dignity Health (Northridge, CA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... pertaining to their practice. + Have an understanding of Utilization Review to progress plan of care....multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- Cedars-Sinai (Tarzana, CA)
- …assigned unit. + Responsible for administrative support activities involving facilities management , pharmacy, utilization management , quality management ... Supervisor is expected to manage the overall unit, is for budget management , scheduling, payroll, overall safety of the unit, policies/procedures are accurate and… more
- Fresenius Medical Center (Irwindale, CA)
- …barriers to quality improvement. This includes promoting the adoption and utilization of Corporate Medical Advisory Board Recommended Algorithms and Standing Orders, ... quality improvement tools and electronic applications. + Performs desk review of facility Quality Assessment and Performance Improvement (QAPI) documentation… more
- Amergis (Orange, CA)
- …+ Documents patient case information within a database system + Performs chart review /audits monthly or as needed + Participates in monthly case conferences by ... referrals for psychosocial needs + Participates in Quality Assurance and Utilization Reviewactivities, as directed + Empowers patients in decision-making for care… more