- Novo Nordisk Inc. (Los Angeles, CA)
- About the Department The Clinical , Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... The Position Territory: Los Angeles, CA Builds relationships and demonstrates the clinical outcome and benefits of NNI products. Educates and demonstrates the… more
- CVS Health (Sacramento, CA)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CenterWell (Sacramento, CA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Centene Corporation (Sacramento, CA)
- … Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II...transfer requests from inpatient facilities within regular timelines. Reviews clinical data in real-time and post admission to issue… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Sharp HealthCare (San Diego, CA)
- …will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM. ... will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM.… more
- Prime Healthcare (Inglewood, CA)
- …and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and … more
- Elevance Health (Walnut Creek, CA)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... to 5:05 PM Pacific. Training hours may vary. The ** Utilization Management Representative I** is responsible for...authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. +… more
- Providence (Mission Hills, CA)
- … clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The ... a 8-hr Day shift.** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical...Utilization Management RN must effectively and efficiently manage a diverse… more
- Dignity Health (Rancho Cordova, CA)
- …CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing utilization management (UM )services. The ... LVN experience. - Clear and current CA Licensed Vocational Nurse (LVN) license. - Knowledge of health plans. Medical...and diagnoses. - Strong knowledge nursing requirements in a clinical setting. Knowledge of utilization management… more
- Emanate Health (Covina, CA)
- …Requirement :** **Minimum Experience Requirement :** Minimum of three years of utilization management experience. Experience in quality- related job preferred. ... States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity… more
- Evolent (Sacramento, CA)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Alameda Health System (Oakland, CA)
- Clinical Nurse V + Oakland, CA + Highland...+ HGH Endoscopy Svcs + Full Time - Day + Management + $64.00- $96.00 + Req #:42809-31789 + FTE:1 + ... nursing unit for which responsible. Promotes effective and economic utilization of personnel and supplies. Monitors utilization ...(1) Three years full time continuous experience as a Clinical Nurse III with AHS. (2) Two… more
- Prime Healthcare (Lynwood, CA)
- …to compassion, quality, and service! Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from the ... admission and across the continuum of the health care management . Works on behalf of the advocate, promoting cost...designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a… more
- Alameda Health System (Oakland, CA)
- Clinical Nurse IV + Oakland, CA +...Hospital + Emergency + Full Time - Night + Management + TBD + Req #:43134-32050 + FTE:1 + Posted:November ... degree in Nursing preferred. Minimum Experience:One year full-time, continuous experience as a Clinical Nurse III or three years experience as a Clinical… more
- Evolent (Sacramento, CA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Sharp HealthCare (Bonita, CA)
- …a defined clinical area. **Required Qualifications** + 2 Years recent, pertinent, clinical experience. + California Registered Nurse (RN) - CA Board of ... End Time** Bachelor's Degree in Nursing; HPCC Certified Hospice and Palliative Nurse (CHPN) - Hospice and Palliative Credentialing Center; AHA Basic Life Support… more
- Ventura County (Ventura, CA)
- …and patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review, case management ... Senior Medical Management Nurse - VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5113983)...in Case Management , CCM. + Experience with Utilization Management and/or Quality Assurance in a… more
- Sharp HealthCare (San Diego, CA)
- …Years acute care clinical experience in area of specialty. + Previous clinical experience with cancer care, case management or patient teaching. + Experience ... (AHA BLS Healthcare) - American Heart Association; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified...and employer business practices. **What You Will Do** The Clinical Case Manager's (CCM) role is to be a… more
