- Prime Healthcare (Lynwood, CA)
- …education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/185693/ case - manager utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. Under the direction of the Utilization Management, Assistant Manager , you will play a key role in processing and ... vital role within a leading health organization. Help ensure smooth and efficient case management processes to support quality care. Take your expertise to the next… more
- UCLA Health (Los Angeles, CA)
- …+ experience in an HMO environment + Thorough knowledge of health care industry, utilization review , utilization management, and concurrent review ... all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll...travel/attend off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified… more
- LA Care Health Plan (Los Angeles, CA)
- …Active, current and unrestricted California License Licenses/Certifications Preferred Certified Case Manager (CCM) Required Training Physical Requirements Light ... implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews...an acute hospital setting. At least 2 years of Utilization Management/ Case Management experience in a hospital… more
- Prime Healthcare (Chino, CA)
- …of the Case Management Department under the direction of the assigned Case Manager /Social Worker in the development and implementation of the discharge plan. ... EDUCATION, EXPERIENCE, TRAINING Required qualifications. 1. Knowledge in discharge planning/ utilization management/ case management terminology and functions, in… more
- Dignity Health (Northridge, CA)
- …dignityhealth.org/northridgehospital (https://www.dignityhealth.org/socal/locations/northridgehospital) for more information. RN Case Manager (Care Coordinator) ... pertaining to their practice. + Have an understanding of Utilization Review to progress plan of care....a clinical or insurance setting is required. + Certified Case Manager (CCM), Accredited Case … more
- Select Medical (Los Angeles, CA)
- …between Cedars-Sinai, UCLA Health and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed ... discharge to home rate. **Benefits of working as a Case Manager with us:** + Excellent Orientation...Coordinates with other departments, ie: Pre-Admissions, Admissions, Patient Accounts, Utilization Review , PPS Coordinator, etc., to assure… more
- Molina Healthcare (Los Angeles, CA)
- …Interqual criteria **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay… more
- Actalent (Ontario, CA)
- Job Title: Inpatient RN Case Manager *For an immediate response, please email me your resume to: olellis @actalentservices.com , along with 3-4 bullet points as ... Job Description We are seeking a dedicated and experienced Case Manager to join our team. The...risk, and/or patient safety as per established protocols. + Review , analyze, and identify utilization patterns and… more
- Cedars-Sinai (Los Angeles, CA)
- …financial patient situations regarding reimbursement issues, social work, discharge planning, utilization review , continuity of care, and systems management. + ... patient situations regarding reimbursement issues, social work, discharge planning, utilization review , continuity of care/readmission avoidance, and systems… more
- UCLA Health (Los Angeles, CA)
- …of safe, high quality, efficient, and cost-effective care. You will also perform utilization review while assuring the delivery of concurrent and post-hospital ... + CA RN License and BLS certification + Recent experience in case management, utilization management and discharge planning + Minimum of three years of acute… more
- Deloitte (Los Angeles, CA)
- …the C-Suite. Our services extend beyond HR to include the CEO, CFO, Risk Manager , and Business Unit leaders, delivering value and creating impact for our clients. ... client expectations and working with leading global businesses? Your RoleAs a Manager in Employer Health, you will provide strategic and technical employee benefit… more
- Sysco (Los Angeles, CA)
- **JOB SUMMARY** The District Sales Manager (DSM) role requires exceptional management of sale performance among Sales Consultants (SCs). This position is responsible ... developing the talent of their sales consultants to achieve profitable planned case and GP growth **RESPONSIBILITIES** + Manages the performance and development of… more
- LA Care Health Plan (Los Angeles, CA)
- …California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or… more
- Dignity Health (Los Angeles, CA)
- …90 days of hire. + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... multiple stakeholders + Professional communication skills. + Understand how utilization management and case management programs integrate....least five (5) years of nursing experience. + Certified Case Manager (CCM), Accredited Case … more
- Elevance Health (Cerritos, CA)
- …mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests involving radiology imaging ... clinical criteria and relevant Carelon Medical Benefits Management policies pertaining to utilization review . + Demonstrate and maintain knowledge of applicable… more
- LA Care Health Plan (Los Angeles, CA)
- …II collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting ... Authorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID:… more
- Elevance Health (Cerritos, CA)
- …Health PulsePoint locations. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of high-tech diagnostic ... Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services and… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …the following areas: Case Management; use of Clinical pathways; or Quality/ Utilization Management and/or Review . Ability to utilize managed care, ... **Purpose Statement/Position Summary:** The Clinical Care Coordinator (CCC), or Case Manager under general supervision, the CCC...The Clinical Care Coordinator (CCC), or Case Manager under general supervision, the CCC acts independently in… more
- Elevance Health (Pico Rivera, CA)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... May collaborate with healthcare providers. Focuses on relatively complex case types that do not require the training or...more junior Clinicians. Approval decisions may be subject to review by more senior nurses or Medical Director. Primary… more