- 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 ... coordination of care. In this role you will perform utilization review while assuring the delivery of...RN License and BLS certification + Recent experience in case management, utilization management and discharge planning… more
- Prime Healthcare (Lynwood, CA)
- …education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/189323/ case - manager utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care… more
- Providence (Mission Hills, CA)
- …working in a remote UR environment or working as an acute hospital case manager . **Preferred Qualifications:** + Bachelor's Degree in Nursing. + Master's ... **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records… more
- LA Care Health Plan (Los Angeles, CA)
- …Active, current and unrestricted California License Licenses/Certifications Preferred Certified Case Manager (CCM) Required Training Physical Requirements Light ... implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews...an acute hospital setting. At least 2 years of Utilization Management/ Case Management experience in a hospital… more
- Dignity Health (Northridge, CA)
- …dignityhealth.org/northridgehospital (https://www.dignityhealth.org/socal/locations/northridgehospital) for more information. RN Case Manager (Care Coordinator) ... pertaining to their practice. + Have an understanding of Utilization Review to progress plan of care....a clinical or insurance setting is required. + Certified Case Manager (CCM), Accredited Case … more
- Select Medical (Los Angeles, CA)
- …between Cedars-Sinai, UCLA Health and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed ... discharge to home rate. **Benefits of working as a Case Manager with us:** + Excellent Orientation...Coordinates with other departments, ie: Pre-Admissions, Admissions, Patient Accounts, Utilization Review , PPS Coordinator, etc., to assure… more
- Molina Healthcare (Los Angeles, CA)
- …Interqual criteria **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay… more
- Cedars-Sinai (Marina Del Rey, CA)
- …our community with the highest quality healthcare! **Position Summary:** As an RN Case Manager (ED Services), you will be responsible for the coordination ... Responsibilities:** + Participates in a multi-disciplinary care team + Utilization review . + Reviews care and treatment...+ Current CA Registered Nurse Licensure, Required + Certified Case Manager CCM or ACM, Preferred **Experience**… more
- Cedars-Sinai (Los Angeles, CA)
- …financial patient situations regarding reimbursement issues, social work, discharge planning, utilization review , continuity of care, and systems management. + ... patient situations regarding reimbursement issues, social work, discharge planning, utilization review , continuity of care/readmission avoidance, and systems… 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 ... teams + Knowledge of a large university teaching hospitals Experience with utilization review and complex discharge planning in an academic tertiary/quaternary… more
- Deloitte (Los Angeles, CA)
- …the C-Suite. Our services extend beyond HR to include the CEO, CFO, Risk Manager , and Business Unit leaders, delivering value and creating impact for our clients. ... client expectations and working with leading global businesses? Your RoleAs a Manager in Employer Health, you will provide strategic and technical employee benefit… more
- LA Care Health Plan (Los Angeles, CA)
- …California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management 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 ... multiple stakeholders + Professional communication skills. + Understand how utilization management and case management programs integrate....least five (5) years of nursing experience. + Certified Case Manager (CCM), Accredited Case … more
- LA Care Health Plan (Los Angeles, CA)
- …II collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting ... Authorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID:… more
- Elevance Health (Los Angeles, CA)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... and/or medical policies. May collaborate with healthcare providers. Focuses on relatively complex case types that do not require the training or skill of a… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …the following areas: Case Management; use of Clinical pathways; or Quality/ Utilization Management and/or Review . Ability to utilize managed care, ... **Purpose Statement/Position Summary:** The Clinical Care Coordinator (CCC), or Case Manager under general supervision, the CCC...The Clinical Care Coordinator (CCC), or Case Manager under general supervision, the CCC acts independently in… more
- Griffith Company (Los Angeles County, CA)
- …methods and sequence of operations. + Coordinate manpower and equipment utilization . + Assist project manager in conducting effective ... Review job costs and budget controls with project manager /foreman. + Monitor processing of timesheet and extra work...to candidates outside of the local area on a case -by- case basis. Visit us at: www.griffithcompany.net. Griffith… more
- Elevance Health (Los Angeles, CA)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... The Med Mgmt Nurse CA is responsible for review of the most complex or challenging cases...skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has… more
- LA Care Health Plan (Los Angeles, CA)
- …by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health ... Worker; current and unrestricted California License. Licenses/Certifications Preferred Certified Case Manager (CCM) Required Training Physical Requirements Light… more
- Elevance Health (Los Angeles, CA)
- …the medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts ... + Extensive orthopedic surgery experience preferred. + Experience with utilization management, especially with CMS guidelines preferred. For candidates working… more