- ERP International (Vandenberg AFB, CA)
- **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Utilization Management ** for a temporary contract position in support of ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- CVS Health (Sacramento, CA)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... 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 ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... and CMS criteria required + A minimum of three years of experience in utilization management , preferred + Team leading or management experience, preferred… more
- The County of Los Angeles (Los Angeles, CA)
- …ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge ... UTILIZATION REVIEW NURSE SUPERVISOR I Print...County of Los Angeles, a Utilization Review Nurse is an RN that has Case Management… 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
- 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
- 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 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Prime Healthcare (Inglewood, CA)
- …Workers, 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
- 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
- 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...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Providence (Mission Hills, CA)
- …strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The ... Utilization Management RN must effectively and efficiently manage a diverse...Qualifications:** + Associate's Degree in Nursing. + California Registered Nurse License upon hire. + 2 years of experience… more
- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** Other; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** ... care. **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse (LVN) - CA… more
- Dignity Health (Rancho Cordova, CA)
- …Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing utilization management (UM )services. The focus is to provide high quality, ... outcomes of patients. **Job Requirements** **Minimum Qualifications:** - 3 years Managed Care/ Utilization Management (UM) experience. - 5 years LVN experience. -… more
- Emanate Health (Covina, CA)
- …Requirement :** **Minimum Experience Requirement :** Minimum of three years of utilization management experience. Experience in quality- related job preferred. ... the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying… 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...accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum… 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
- Ventura County (Ventura, CA)
- …Inpatient Psychiatric unit of the Ventura County Medical Center including utilization management , transfer coordination, discharge planning, and securing ... CANDIDATE The ideal candidate is an experienced Mental Health Nurse with a background in utilization review...and review; + Performs daily clinical reviews to support utilization and quality management , ensuring compliance with… more
- Actalent (Santa Barbara, CA)
- … Nurse assigned to various Health Services operational units. These units include Utilization Management , Case Management , Enhanced Care Management , ... Job Title: Health Plan Nurse CoordinatorJob Description The Health Plan Nurse...Model, and Population Health programs. The role involves performing utilization management activities, including telephonic or onsite… more
- Dignity Health (Northridge, CA)
- **Job Summary and Responsibilities** As an ED Nurse Leader at Dignity Health- Northridge Hospital Medical Center, now part of CommonSpirit Health, the largest ... how to quickly get you the care you need. **Northridge Medical Center** **Emergency Services** ** Nurse Shift Manager - Nights 12hrs shift** As an ED Nurse Leader… more