- Providence (Mission Hills, CA)
- **Description** Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective ... them. **Required qualifications:** + Nursing school graduate. + California Registered Nurse License upon hire + 3...License upon hire + 3 years of experience in utilization management and/or case management. + 3 years of… 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 $118,161.60 -… more
- Molina Healthcare (Los Angeles, CA)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Managed Care Utilization Management and knowledge… more
- Providence (Mission Hills, CA)
- …must empower them. **Required Qualifications:** + Associate's Degree in Nursing. + California Registered Nurse License upon hire. + 2 years of experience working ... Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse… 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...accepted for current UCLA Health Nursing staff) + CA RN License and BLS certification + Recent experience in… more
- Select Medical (Los Angeles, CA)
- …Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse ( RN ) or Licensed Clinical Social Worker (LCSW) **Pay Rate: ... + Coordinates with other departments, ie: Pre-Admissions, Admissions, Patient Accounts, Utilization Review , PPS Coordinator, etc., to assure positive fiscal… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity… more
- Prime Healthcare (Lynwood, CA)
- …experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/189323/case-manager utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySt. Francis Medical Center… more
- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Nurse , you will be responsible for: + Ensuring appropriate, cost-effective, and high-quality care ... for New Century Health Plan members + Conducting utilization management (UM) activities in accordance with health plan...BSN or MSN degree, required * Current valid California RN license, required * Two or more years of… 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
- Molina Healthcare (Los Angeles, 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
- 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
- Cedars-Sinai (Marina Del Rey, CA)
- …Duties and Responsibilities:** + Participates in a multi-disciplinary care team + Utilization review . + Reviews care and treatment for appropriateness against ... Bachelor's or Master's Degree in Nursing, Preferred **License/Certification:** + Current CA Registered Nurse Licensure, Required + Certified Case Manager CCM or… more
- Dignity Health (Los Angeles, CA)
- …90 days of hire. + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... care systems. Visit https://www.dignityhealth.org/socal/locations/californiahospital for more information. **Responsibilities** The RN Care Coordinator is responsible for overseeing the progression… 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...Knowledge of a large university teaching hospitals Experience with utilization review and complex discharge planning in… more
- UCLA Health (Los Angeles, CA)
- …other relevant documents, and conducting a pre-operative phone interview (or on-site clinical review ) of the patient. The RN will apply critical thinking ... Description The staff RN is a professional caregiver who provides pre-operative...the creation of educational teaching material for patient care/staff utilization . Working knowledge of various CareConnect templates for the… more
- Cedars-Sinai (Beverly Hills, 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
- Cedars-Sinai (Tarzana, CA)
- …will you be doing in this role?** The Supervisor, Clinical Operations Oncology RN is responsible for supervising the clinical staff and clinical operations of the ... 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
- Elevance Health (Los Angeles, CA)
- …care for wound care. + Promotes healing and decrease home care utilization . + Responsible for certification determinations and sending written authorizations to ... do not meet coverage guidelines criteria to Physician for review . + Uses clinical judgment in authorizations that fall...provides an equivalent background. + Current active valid unrestricted RN license to practice as a health professional within… 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