- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and… more
- Elevance Health (Woodland Hills, CA)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/163839/rn-case-manager 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
- Dignity Health (Northridge, CA)
- …setting required. + Current CA Registered Nurse (RN) license + Prior Utilization Management experience in a clinical or insurance setting required. + ... 400 care centers. Visit dignityhealth.org/northridgehospital for more information. The RN Utilization Management Coordinator (UMC) is responsible for assessing… more
- UCLA Health (Los Angeles, CA)
- …of Hepatobiliary disease. Additional responsibilities include data collection for clinical management . The Liver Cancer Clinical Nurse reports directly to ... Description The Liver Cancer Clinical Nurse is a professional registered nurse who assumes responsibility and accountability for patients within the… more
- Guidehouse (Los Angeles, CA)
- …two years' experience in nursing or one-year related nursing experience in utilization review /insurance/case management /medical clearance. * Graduation from ... **Job Family** **:** Patient Access Nurse **Travel Required** **:** None **Clearance Required** **:**...Nice To Have** **:** * Two years' experience in utilization review with external payors within a… more
- LA Care Health Plan (Los Angeles, CA)
- …in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The expected pay range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
- The County of Los Angeles (Los Angeles, CA)
- …the following: + Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT ... the work of staff, and evaluating employee performance. For this examination, Utilization Review is defined as provides technical and administrative direction… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the RN Asst. Director for Utilization Review , Intensive Case Management , you will support and perform duties to provide ... discharge planning/ UM concurrent review of the complex cases admitted in Non Domestic...BSN Degree + Minimum of 2 years' experience in utilization management , Inpatient CM or clinical Experience… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestricted California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Manager, Enhanced Care Management (RN or LCSW) Job Category: Clinical Department:...ECM services to medically and behaviorally complex members. + Review systems and processes, making recommendations for improvement to… more
- LA Care Health Plan (Los Angeles, CA)
- …by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health ... Care Management Specialist II Job Category: Clinical Department: Care...Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse (RN);current and unrestricted California License OR Licensed Clinical… more
- Cedars-Sinai (Beverly Hills, CA)
- …of patient care and nursing practices within assigned clinical unit(s). Works with Nurse Management to address issues identified with regard to quality of ... **Job Summary: Key Job Responsibilities** Under the leadership of the Nurse Manager/Associate Director/Executive Director ( Nurse Leader) the Assistant … 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
- Cedars-Sinai (Beverly Hills, CA)
- …budgets. + Executes on leader standard work. Meets requirements for Daily Management Systems. Monitors organizational metrics with review and analysis in ... oversight and management of efficiency. Participates in the evaluation and review of all human resources and communicates issues appropriately and partners with… more
- Insight Global (Los Angeles, CA)
- …practice is preferred. Experience in chronic disease management , case management , utilization management and quality improvement projects. Bilingual ... Job Description Insight Global is seeking a skilled Registered Nurse Supervisor for a community health/wellness clinic in LA county. The position incorporates… 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
- Cedars-Sinai (Marina Del Rey, CA)
- …Duties and Responsibilities:** + Participates in a multi-disciplinary care team + Utilization review . + Reviews care and treatment for appropriateness against ... (ED Services), you will be responsible for the coordination and implementation of case management strategies pursuant to the Case Management Plan. You will plan… more
- Amergis (Los Angeles, 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