- 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 ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity… more
- Dignity Health (Glendale, CA)
- …the individual to competently perform the job. + Five (5) years experience in utilization review and discharge planning, case management and managed care. Other ... capitated to the Dignity Health hospitals (as well as participation in In-Network Utilization management). in the GSSJSA and to provide support to the Director,… more
- Prime Healthcare (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with...with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA)… more
- Insight Global (Orange, CA)
- …care is being delivered Participates in the Outcomes Management and annual program review Performs utilization review of continuous care and inpatient ... Verifies/approves admitting IPOC diagnosis, treatments, staffing and supplies Monitors utilization of resources by every patient to assure cost effective… more
- Emanate Health (Covina, CA)
- …of California, and hospital policies, goals, and objectives. Completes Utilization Review of Behavioral Health Services. Charge Nurse will have expert ... States, and the #19 ranked company in the country. **Job Summary** The Charge Nurse is responsible for supervising staff and the operation and overall flow of the… more
- STG International (Rancho Cucamonga, CA)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. + ... safety. + Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement… more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- …Associates degree. Three years acute hospital experience; one year experience in Utilization Review or Case Management; discharge planning and/or case ... of care. May perform other duties as assigned. Job Qualifications: [Required] Valid unrestricted California RN License. Graduate of accredited School of Nursing with… more
- Cedars-Sinai (Tarzana, CA)
- …will you be doing in this role?** The Supervisor, Clinical Operations Oncology RN is responsible for supervising the clinical staff and clinical operations of the ... policies/procedures are accurate and complete, appropriate staffing levels. Although not a staff nurse , will be expected to step into direct patient care if urgent… more
- Amergis (Orange, CA)
- …help support a health insurance agency! The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for ... providers. The incumbent will be responsible for prior authorizations, concurrent review and related processes. Position Details: Location: Orange (Full Office, no… more