- 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 facilitates, coordinates, and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, ... net required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse ...submit to the department's Quality Assurance Team and UM Management . Duties Facilitates the development, review , and… more
- Cedars-Sinai (Los Angeles, CA)
- …as a condition of continued employment. **Req ID** : 5044 **Working Title** : Registered Nurse - Utilization Management 8 Hour Days Per Diem **Department** : ... Hospitals! **What You Will Do in This Role:** The Utilization Review Case Manager validates the patient's... Utilization Management **Business Entity** : Cedars-Sinai Medical Center **Job Category**… more
- 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
- UCLA Health (Los Angeles, CA)
- …+ Monitor members/patients followed by Case Management + Work directly with a nurse team lead + Review pending claims for approval or denial Salary Range: ... more at UCLA Health. Under the direction of the Utilization Management , Assistant Manager, you will play...and prepare necessary documents for the next level of review + Maintain and prepare specific reports and manage… 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
- LA Care Health Plan (Los Angeles, CA)
- …nursing experience in direct patient care, such as ambulatory care, home care, or case management . OR experience in Utilization Review or Care Management ... Managed Long Term Services and Supports Nurse Specialist RN II Job Category: Clinical Department:...a case/care management environment. Preferred: Experience in utilization review , skilled nursing, home health, discharge… more
- Veterans Affairs, Veterans Health Administration (Los Angeles, CA)
- …HBPC policies and procedures to include performance improvement, patient safety, utilization review , emergency preparedness, and staff safety. Responsible for ... Greater Los Angeles Healthcare (VAGLAHS) is seeking a highly skilled/experienced Registered Nurse to serve as Home Base Primary Care (HBPC) Program Director.… 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
- Molina Healthcare (Los Angeles, 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
- LA Care Health Plan (Los Angeles, CA)
- …health care resource utilization . Assures appropriate staff support of Utilization Management and other relevant committees. Supports the maintenance of ... Director, Care Management Job Category: Clinical Department: Care Management...goals and staff training based on data analysis and review . Responsible for the Policies, Procedures, Budget and Program… more
- LA Care Health Plan (Los Angeles, CA)
- …Clinical Auditor RN II is responsible for ensuring that delegates contracted to perform Utilization Management (UM) functions on behalf of LA Care (LAC) is in ... also acts as a liaison between the Plan Partners, PPGs and Vendors regarding Utilization Management (UM) issues; assists in improving access and utilization … 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
- Pipeline Health System, LLC (East Los Angeles, 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