- Dignity Health (San Bernardino, CA)
- …Visit https://www.dignityhealth.org/socal/locations/san-bernardino for more information. **Responsibilities** The Utilization Review Specialist is responsible ... field in lieu of 1 year experience. + California RN license. + AHA BLS + Ability to pass...+ Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Proficient in… more
- Prime Healthcare (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with...with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA)… more
- Dignity Health (Northridge, CA)
- …programs integrate. + Knowledge of CMS standards and requirements. **Qualifications** + CA Registered Nurse ( RN ) License required. + Minimum two (2) ... Federal or State regulations pertaining to their practice. + Have an understanding of Utilization Review to progress plan of care. + Understand how … more
- HCA Healthcare (Riverside, CA)
- …a balance of optimal care and appropriate resource utilization . **Requirements:** + Registered Nurse ( RN ) with current California license required, Case ... join an organization that invests in you as an RN Case Manager? At Riverside Community Hospital, you come...Management Certification or utilization review preferred + Associate's Degree minimum… more
- Insight Global (Orange, CA)
- …care is being delivered Participates in the Outcomes Management and annual program review Performs utilization review of continuous care and inpatient ... Verifies/approves admitting IPOC diagnosis, treatments, staffing and supplies Monitors utilization of resources by every patient to assure cost effective… more
- ICW Group (Woodland Hills, CA)
- …providing direct clinical care required. **CERTIFICATES, LICENSES, REGISTRATIONS** Current unrestricted Registered Nurse ( RN ) or Licensed Vocational ... regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and… more
- Elevance Health (Placentia, CA)
- …relatively complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians. Approval decisions ... a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid...review experience. + Current active, valid and unrestricted RN license and/or certification to practice as a health… more
- Amergis (Orange, CA)
- …Pay: $50 - $55/hour dependent on experience Preferred Qualifications: + Prior authorization/ utilization review experience. + Managed care experience. + Post ... Orange, California! The Care Manager is responsible for the oversight and review of Behavioral Health Treatment (BHT) including Applied Behavior Analysis (ABA)… more
- STG International (Rancho Cucamonga, CA)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. + ... safety. + Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement… more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- …Management position. One-two years' experience in Leadership, Discharge Planning, and Utilization review . Ability to demonstrate excellent verbal and written ... May perform other duties as assigned. Position Qualifications: [Required] - Current CA RN License. Bachelor's Degree in Nursing required within 2 years of hire into… more
- Molina Healthcare (Riverside, CA)
- …acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must ... California residents preferred. California RN licensure required.** **Work Schedule: Monday thru Friday, 10:00AM to 7:00PM with some weekends and holidays. Pacific… more
- Cedars-Sinai (Tarzana, CA)
- **Job Description** The Supervisor, Clinical Operations Oncology RN is responsible for supervising the clinical staff and clinical operations of the Oncology ... policies/procedures are accurate and complete, appropriate staffing levels. Although not a staff nurse , will be expected to step into direct patient care if urgent… more
- Fresenius Medical Center (Irwindale, CA)
- …related field preferred or an equivalent combination of education and experience + Registered Nurse required + Certification in Nephrology Nursing or quality ... barriers to quality improvement. This includes promoting the adoption and utilization of Corporate Medical Advisory Board Recommended Algorithms and Standing Orders,… more
- Veterans Affairs, Veterans Health Administration (Loma Linda, CA)
- Summary The Nurse Practitioner (NP) is a RN with advanced education and experience. He/she applies specialized clinical nursing knowledge and skills to patient ... utilization in the work setting. 14. Maintains workload review data. 15. Analyzes workload for decision-making. 16. Identifies...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- HCA Healthcare (Riverside, CA)
- …track and report sepsis data to the Quality department and tracks/encourages the utilization of the sepsis order sets **What qualifications you will need:** + ... in Nursing required, Master's degree preferred + Current CA RN license + Minimum 3-5 years of Acute care,...for our Sepsis Coordinator opening. Our team will promptly review your application. Highly qualified candidates will be contacted… more