- Innovative Management Systems Incorporated (City Of Industry, CA)
- …UM Case ManagerUM Case Manager implements the effective and best practices of Utilization Management. The UM Case Manager will provide high quality medical care ... review and service by appropriately applying the Milliman Care...document and communicate all aspects of the precertification and utilization /benefit management program.. Utilizes clinical experience and skills in… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR...CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board ... II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $113,309.04 -… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/163839/* rn -case-manager utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April… more
- Providence (Mission Hills, CA)
- …must empower them. **Required Qualifications:** + Associate's Degree - Nursing. + California Registered Nurse License upon hire. + 2 years - Experience working ... Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse… more
- Dignity Health (Northridge, CA)
- …nursing experience in an acute hospital setting required. + Current CA Registered Nurse ( RN ) license + Prior Utilization Management experience in a ... than 400 care centers. Visit dignityhealth.org/northridgehospital for more information. The RN Utilization Management Coordinator (UMC) is responsible for… 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 provide direct management to a team of UM coordinators and… more
- Molina Healthcare (Los Angeles, CA)
- **JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE ** **For this position we are seeking a ( RN ) Registered Nurse with ... previous experience in Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. CALIFORNIA… more
- Molina Healthcare (Los Angeles, CA)
- …will move to a 3 day/12 hour shift from then on._** **_Previous experience with Utilization Management / Utilization Review is very essential to this role. ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- The County of Los Angeles (Los Angeles, CA)
- …clinical nursing. LICENSE(S) AND CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board or Registered ... in a state other than California must provide their Registered Nurse License Number from that state...Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL… more
- Pipeline Health System, LLC (East Los Angeles, CA)
- …Manager (CM) performs a wide variety of tasks and functions. These include utilization review , discharge planning, care coordination and variance management to ... team to ensure coordination of patient care and wise utilization of resources. + Documents case management activities in...record and in the required information system. + The RN CM reports to the Director/Manager of the department.… more
- Pipeline Health System, LLC (Huntington Park, CA)
- …Manager (CM) performs a wide variety of tasks and functions. These include utilization review , discharge planning, care coordination and variance management to ... team to ensure coordination of patient care and wise utilization of resources. + Documents case management activities in...record and in the required information system. + The RN CM reports to the Director/Manager of the department.… more
- Fresenius Medical Center (Harbor City, CA)
- **PURPOSE AND SCOPE:** The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) ... for new employees who meet the RN CAP 2 criteria or attained through...the Clinical Educator, Preceptor or in collaboration with other Registered Nurses. + Performs ongoing, systematic collection and analysis… more
- LA Care Health Plan (Los Angeles, CA)
- …Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse ( RN ); current and unrestrited California License. ... Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required Training Physical Requirements Light… more
- LA Care Health Plan (Los Angeles, CA)
- …(HMO) & Independent Practice Association (IPA) contracts and payers. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and ... achieve that purpose. Job Summary The Clinical Assurance Compliance Nurse Specialist RN II is responsible for the review of regulatory, contractual and… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the RN Asst. Director for Utilization Review , Intensive Case Management, you will support and perform duties to provide ... discharge planning/ UM concurrent review of the complex cases admitted in Non Domestic...aim to foster continuity of care and reduce unnecessary utilization of healthcare services by coordinating and providing health… more
- Fresenius Medical Center (South El Monte, CA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… 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 ... accepted for current UCLA Health Nursing staff) + CA RN License and BLS certification + Recent experience in...and BLS certification + Recent experience in case management, utilization management and discharge planning + Minimum of three… 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 ... accepted for current UCLA Health Nursing staff) + CA RN License and BLS certification + Recent experience in...and BLS certification + Recent experience in case management, utilization management and discharge planning + Minimum of three… more
- UCLA Health (Santa Monica, 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 ... problem solver with: + BSN or MSN + CA RN License and BLS + Recent experience in case...License and BLS + Recent experience in case management, utilization management and discharge planning + Minimum of three… more
- Dignity Health (Long Beach, CA)
- …of patient satisfaction. The RN Care Coordinator consistently conducts the utilization review process and the discharge planning process as required by ... regulations. * Minimal Travel (less than 10%) **Qualifications** Minimum + Current Registered Nurse ( RN ) license. + Minimum of 3 years nursing experience… more
