- Scripps Health (San Diego, CA)
- …preferred. **Job:** **Pt Care Technical* **Organization:** **Scripps Health Corp* **Title:** * Quality LVN - Utilization Review - Remote within San Diego ... will:* * Conduct regular file audits to ensure compliance with regulations * Analyze quality data and trends to identify areas for improvement * Participate in the… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …The Utilization Review Specialist ( LVN ) will support the Utilization Review quality assurance initiatives including mock audits to ensure ... **Responsibilities** The Utilization Review Specialist ( LVN )...as we continue to grow, our focus is providing quality patient care by adding to our team of… more
- UCLA Health (Los Angeles, CA)
- …with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, or health plan ... more at UCLA Health. You will play a key part in promoting high- quality , cost-effective medical care by applying clinical acumen and applicable policies and… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... Certification - Various-Employee provides certificate; California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians;… more
- Molina Healthcare (Riverside, CA)
- …seeking a LVN (Licensed Vocational Nurse) with experience in Prior Authorizations, Utilization Review / Utilization Management and knowledge of Interqual ... HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of… more
- Sharp HealthCare (La Mesa, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... (AHA BLS Healthcare) - American Heart Association; California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours**… more
- Banner Health (Susanville, CA)
- …management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process ... full-time employee is one who works as an independent LVN , supporting our back office team for the family...nurse and/or licensed physician, and is accountable for the quality of nursing services delivered by self or others… more
- STG International (Milledgeville, GA)
- …our Georgia Ware Veterans Home. JOB SUMMARY: The primary purpose of the lead LPN/ LVN is to provide direct nursing care to the residents. ESSENTIAL FUNCTIONS: + ... forms, reports, evaluations, studies, charting, etc., as necessary. + Periodically review the department's policies and procedures manuals, job descriptions, etc.,… more
- Hospice Of San Joaquin (Stockton, CA)
- …sources and the community about the Hospice philosophy and Hospice's services. QUALITY ASSESSMENT/IMPROVEMENT AND UTILIZATION REVIEW : Ensures compliance with ... of everything we do. We seek a Dynamic, self-motivated LVN - PM Float who thrives in a fast-paced...appropriate utilization of resources. + Participates in Quality Assessment/Improvement and Utilization Review … more
- Hospice Of San Joaquin (Stockton, CA)
- …Policies and Procedures including the Hospice of San Joaquin Compliance manual. QUALITY ASSESSMENT/IMPROVEMENT AND UTILIZATION REVIEW : Ensures compliance ... we do. We are seeking a Dynamic skilled, self-motivated LVN Nurse - PM Shift who thrives in a...appropriate utilization of resources. + Participates in Quality Assessment/Improvement and Utilization Review … more
- The Cigna Group (Harlingen, TX)
- …skills * Typing and computer knowledge- able to type 35WPM * Knowledge of utilization review requirements and procedures * Knowledge of current health care ... ensure all customers in participating provider practices meet all quality metrics. Responsible for coordinating the delivery of cost-effective,...Duties as assigned. **Experience:** * Current Licensure as a LPN/ LVN or RN, in the state of Texas in… more
- Cedars-Sinai (Culver City, CA)
- …liaison, for administrative support activities including facilities management, pharmacy, utilization management, quality management, risk management, human ... Award 19 years in a row for providing the highest- quality medical care in Los Angeles. We were also...of the medical practice(s). 2. Assists in the development, review , and revision of standard operating policies and procedures… more
- Amergis (Orange, CA)
- …entitlements,resources, information, and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Reviewactivities, as directed + ... The LPN/ LVN Case Manager is responsible for coordinatingcontinuum of...case information within a database system + Performs chart review /audits monthly or as needed + Participates in monthly… more
- The Cigna Group (El Paso, TX)
- …ability . Typing and computer knowledge- able to type 35WPM . Knowledge of utilization review requirements and procedures . Knowledge of current health care ... Primary Function: Responsible for coordinating the delivery of cost-effective, quality -based health care services for health plan customers by development and… more
- Elevance Health (Tampa, FL)
- **Licensed Utilization Review II** **Location** : KS, FL. and VA. This is a remote position The ideal candidate will live within 50 miles Elevance Health ... **Hours** **: Monday through Friday,10:30 - 7:00 Eastern time** The **Licensed Utilization Review II** responsible for working primarily with healthcare… more
- Molina Healthcare (NV)
- …performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... state at this time.** **Prior experience with managed care (Medicaid, Medicare) Utilization Management processes and 3 + years in management / staff oversight… more
- Tenet Healthcare (Detroit, MI)
- …to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patients resources and right to ... national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition Management… more
- Integra Partners (Troy, MI)
- …do whatever it takes to get things done. PREFERRED SKILLS: + Certification in Utilization Review or Case Management + Experience with health insurance operations ... & Development team as an Operations UM Training Specialist, specializing in Utilization Management (UM) processes. The ideal candidate will have a strong nursing… more
- Banner Health (Mesa, AZ)
- …management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process ... **four-star home care agency** **with a track record for quality and excellence** **and** **is** **the largest** **skilled home...MINIMUM QUALIFICATIONS Must possess a current, valid LPN or LVN license in state of practice, temporary LPN or… more
- US Tech Solutions (Columbia, SC)
- …PREFERRED/NICE TO HAVE skill sets/qualities: I would love to have someone with prior insurance/ utilization review experience, but I know that is not very common. ... any of the following in support of medical claims review and utilization review practices:...members and providers on all rendered determinations. Participates in quality control activities in support of the corporate and… more