- 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, ... in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely...for appropriate care and setting while working closely with denial coordinators and other staff to ensure the accurate… more
- UCLA Health (Los Angeles, CA)
- …point of contact for receiving and resolving member denials. You will review denials for accuracy, confirming the receipt of necessary documentation to support ... the denial and ensuring compliance with all contractual obligations and state and federal laws/regulations. You will extrapolate and summarize essential information… more
- Robert Half Office Team (Monterey Park, CA)
- Description The Utilization Management Nurse Specialist LVN promotes the quality and cost effectiveness of medical care by applying clinical acumen and the ... review depending on case findings. Functions & Job Responsibilities * The Utilization Management Nurse Specialist LVN will facilitate, coordinate, and approve… 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 Position ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve… 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 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve… more
- UCLA Health (Los Angeles, CA)
- …+ experience in an HMO environment + Thorough knowledge of health care industry, utilization review , utilization management , and concurrent review ... can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team of UM… more
- UCLA Health (Los Angeles, CA)
- …Working directly with Concurrent Nurses and Intensive Case Management Nurses + Review pending claims for approval or denial + Provide timely care ... Guidelines, identifies documents needed to assist the next level of reviewer in review , and health plan contracts. The Case Management Coordinator will also… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... achieve that purpose. Job Summary The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative and… more
- Robert Half Management Resources (Monterey Park, CA)
- …Nursing preferred. . Active California LPN/LVN or RN license. . Three (3) years of utilization management experience in a managed care setting. . Two (2) years ... of clinical nursing experience . Knowledge of utilization management principles and healthcare managed care. . Experience with medical decision support tools… more
- Banc of California (Pasadena, CA)
- …procedures and state and federal regulations. + Effectively executes on contact management strategy through utilization of available tools and resources ... in person meetings. Regularly meets with internal business partners to communicate and review business results and pipeline management . + Treats people with… more
- The County of Los Angeles (Los Angeles, CA)
- …methods include group, family, individual and conjoint therapy, clinical case management , and crisis intervention. Positions allocable to this class also provide ... problem, which may include individual, group, family or marital counseling, case management , and/or referral to another treatment source such as a psychiatrist, a… more