- Children's Hospital Los Angeles (Los Angeles, CA)
- …of healthcare services provided to all admitted patients. Using a value-based approach the Utilization Review Nurse ensures that care is administered via ... Work That Matters.** **Overview** **Purpose Statement/Position Summary:** The Utilization Nurse is responsible for utilization review including medical… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW ... comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW ... and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices....support and review of medical claims and utilization practices. Complete medical necessity and level of care… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established… more
- ICW Group (Woodland Hills, CA)
- …AND SKILLS** Understanding of Workers' Compensation, Workers' Compensation Managed Care processes, Utilization Review , Telephonic Nurse Case Management, and ... in tracking, resolution gathering, and trending of cost management issues related to bill review , case management and utilization review . + Works closely… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Elevance Health (Los Angeles, CA)
- …Obtains intake (demographic) information from LTSS providers. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty ... ** Utilization Management Representative II** **Location:** Virtual: This role...+ Processes incoming requests, collection of information needed for review from providers. + Verifies benefits and/or eligibility information.… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive… more
- Elevance Health (Los Angeles, CA)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Location** : This role...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Prime Healthcare (San Dimas, CA)
- …effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service ... post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 years post… more
- The County of Los Angeles (Los Angeles, CA)
- …Please include the exam number and exam title. + Yes + No 08 NURSE PRACTITIONER CANDIDATE ASSESSMENT RATING FORMINSTRUCTIONS Review the four competency areas and ... an individual's ability to perform as based on core competencies for the nurse practitioner disciplines. Review and consider your resume, education, experience,… more
- The County of Los Angeles (Los Angeles, CA)
- …Please include the exam number and exam title. + Yes + No 08 NURSE PRACTITIONER CANDIDATE ASSESSMENT RATING FORMINSTRUCTIONS Review the four competency areas and ... an individual's ability to perform as based on core competencies for the nurse practitioner disciplines. Review and consider your resume, education, experience,… more
- The County of Los Angeles (Los Angeles, CA)
- …an individual's ability to perform as based on core competencies for the nurse practitioner disciplines. Review and consider your resume, education, experience, ... NURSE PRACTITIONER- PEDIATRIC HUB CLINICS/NORTH COUNTY Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2588395) Apply NURSE PRACTITIONER-… more
- Cedars-Sinai (Los Angeles, CA)
- …plans to track outcomes for patients in value-based programs, including utilization , cost, efficiency, and appropriateness metrics, as well as clinical outcomes. ... home department and Clinical Efficiency & Value team to review outcomes of the programs, address barriers to success,...Three (3) plus years' Experience as an Advance Practice Nurse . (preferred) + Two (2) plus years' experience in… more
- Molina Healthcare (Los Angeles, CA)
- …in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), ... managing performance of one or more of the following activities: care review , care management, transition of care, health management, behavioral health, long-term… more
- Cedars-Sinai (Los Angeles, CA)
- …Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of Joint ... preferred Foreign trained MDs will be considered License/Certifications: Registered Nurse , LVN, Occupational Therapist, Physical Therapist, Physician Assistant, foreign… more
- Elevance Health (Los Angeles, CA)
- **Telephonic Nurse Case Manager II** **Sign on Bonus: $2000.** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Fresenius Medical Center (Pasadena, CA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Molina Healthcare (Los Angeles, CA)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
