- Emanate Health (Covina, CA)
- …Education Requirement:** **Minimum Experience Requirement:** Minimum of three years of utilization management experience. Experience in quality - related ... #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records...keep well in body, mind and spirit by providing quality health care services in a safe, compassionate environment.… more
- 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, ... 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
- UCLA Health (Los Angeles, CA)
- …for assessing and coordinating care for a diverse group of patients. This in-patient utilization review case manager position will work on-site at our UCLA ... coordination of care. In this role you will perform utilization review while assuring the delivery of...License and BLS certification + Recent experience in case management , utilization management and discharge… more
- Prime Healthcare (Lynwood, CA)
- …Responsibilities Responsible for the quality and resource management ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200415/case-manager%2c-rn utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySt. Francis Medical Center… more
- LA Care Health Plan (Los Angeles, CA)
- …Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management (CM). Knowledge of Department ... Utilization Management Nurse Specialist RN II...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and… 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 ... or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan +… more
- Providence (Anaheim, CA)
- …+ Medical Assistant Certification (CMA) upon hire. + 1 year of experience in utilization management or case management with experience in medical terminology ... **Description** Under the direction of the Utilization Supervisor/ Manager, this position is responsible for...Supervisor/ Manager, this position is responsible for the distribution, review , accurate and timely processing of SJHH patient referrals… more
- Prime Healthcare (Anaheim, CA)
- …Responsibilities Responsible for the quality and resource management ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/199249/case-manager utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityWest Anaheim Medical Center… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …one of the following areas: Case Management ; use of Clinical pathways; or Quality / Utilization Management and/or Review . Ability to utilize managed ... care, utilization management , and discharge planning concepts. Computer Literacy. Well-developed written and verbal communication skills. Demonstrated… more
- Molina Healthcare (Los Angeles, CA)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- UCLA Health (Los Angeles, CA)
- …five years of Managed Care experience required + Minimum three years of experience in Utilization Management or Quality Management required + Ability to ... Description The Quality Management Nurse Specialist serves as...complaints/appeals: Gather and organize key information, ensuring a thorough review . Consult with Medical Directors as needed to finalize… more
- UCLA Health (Los Angeles, CA)
- …and trending of all Health Plan initiated grievances and appeals received within the Quality Management department. This position will act as the primary contact ... experience (ie, MSO, IPA, or health plan) required + Working knowledge of utilization review /referral processing systems (ie, EPIC) + Working knowledge of CPT-4,… 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
- Molina Healthcare (Los Angeles, CA)
- …Managed care (MCO). **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **Work Schedule: Monday ... 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
- Prime Healthcare (Lynwood, CA)
- … Program. Provides leadership and supervision to case managers, case management coordinators/discharge planners, utilization review coordinators and ... quality improvement tools . Responsible for the quality and resource management of all patients... Management position. Experience in discharge planning / utilization management / case management … more
- Fresenius Medical Center (Irwindale, CA)
- …to quality improvement. This includes promoting the adoption and utilization of Corporate Medical Advisory Board Recommended Algorithms and Standing Orders, ... quality improvement tools and electronic applications. + Performs desk review of facility Quality Assessment and Performance Improvement (QAPI) documentation… 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 ... (DMHC) regulations, applicable state and federal regulations, National Committee on Quality Assurance (NCQA) CM Certification, Management Services Agreements &… 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
- Elevance Health (Los Angeles, CA)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... members in different states; therefore, Multi-State Licensure will be required** The **Medical Management Nurse** is responsible for review of the most complex… more
- UCLA Fielding School of Public Health (Los Angeles, CA)
- …medicine/patient blood management , education of physicians regarding test utilization and interpretation, and active engagement in quality assurance ... Faculty Transfusion Medicine and Patient Blood Management Physician Apply now to Faculty Transfusion Medicine...Application Window Open date: May 23, 2024 Most recent review date: Friday, Feb 28, 2025 at 11:59pm (Pacific… more