- Cedars-Sinai (Los Angeles, CA)
- …CDIP OR CPC, required Experience: A minimum of 5 years of experience in Acute Clinical Care , Utilization Review , Coding, or Case Management required ... World Report has named us one of America's Best Hospitals. As our next Clinical Documentation Specialist, you will work under the general direction of the HID… more
- CenterWell (Sacramento, CA)
- … clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity ... and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- Genesis Healthcare (Carmichael, CA)
- …rehabilitation department, including oversight related to case management, quality improvement, care planning, clinical utilization , and patient ... Director in the timely completion of the annual merit review for therapy staff. 7. Assists Clinical ...utilization with input from treating therapists, consideration of clinical requirements, and recommendations from the Clinical … more
- Elevance Health (Walnut Creek, CA)
- **Nurse Reviewer I** Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... work weekends if necessary. New Grads are encouraged to apply! The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network and… more
- CVS Health (Sacramento, CA)
- …use of health care resources. Under the direction of the Lead Clinical Psychologist, this position will focus on utilization , quality, and review ... disorders. + Make recommendation for enhancements to current managed care , review guidelines, and clinical ...clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods,… more
- Providence (Napa, CA)
- **Description** Care Manager RN - Utilization Review unit at Providence Queen of the Valley Medical Center in Napa, CA. This position is Full-Time and will ... opportunities for advancement. **Requsition ID:** 381272 **Company:** Providence Jobs **Job Category:** Care Management **Job Function:** Clinical Care **Job… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one… more
- Genesis Healthcare (Elk Grove, CA)
- …rehabilitation department, including oversight related to case management, quality improvement, care planning, clinical utilization , and patient ... therapists, consideration of clinical requirements and recommendations from the Regional Clinical Director. 8. Continues direct patient care . 9. Assists the… more
- Sutter Health (Sacramento, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care , and observation status. + Some ... organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA...compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on cases referred by UM/CM staff and… more
- Dignity Health (Woodland, CA)
- …of Woodland, CA, with occasional onsite meetings in Woodland.** **Position Summary:** The Utilization Review LVN uses clinical judgement in providing ... services. The focus is to provide high quality, cost-effective care which will enable patients to achieve maximum medical...LVN license. - Strong knowledge nursing requirements in a clinical setting. - Knowledge of utilization management… more