- Prime Healthcare (Lynwood, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum...of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five… more
- Prime Healthcare (Huntington Beach, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum...of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five… more
- Prime Healthcare (Inglewood, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... illness. Qualifications EDUCATION, EXPERIENCE, TRAINING 1. A current California State Registered Nurse (RN) license is required. 2. Five years acute care nursing… more
- Prime Healthcare (Inglewood, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... illness. Qualifications EDUCATION, EXPERIENCE, TRAINING 1. A current California State Registered Nurse (RN) license is required. 2. Five years acute care nursing… more
- LA Care Health Plan (Los Angeles, CA)
- …prospective, concurrent , post-service, and retrospective claim medical review processes. Utilizes clinical judgement, independent analysis, critical-thinking ... and processes. Actively participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care, home… more
- University of Southern California (Alhambra, CA)
- …8. Perform telephonic, and if appropriate, on-site initial/ concurrent review on identified in-patient members. Direct pertinent clinical ... quality patient care. The Case Manager will leverage their clinical and social work experience to ring an understanding...of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate… more
- Sharp HealthCare (La Mesa, CA)
- …real and potential quality issues through measurement and analysis along with concurrent and retrospective review of performance information. Assists with ... and managing data collection as well as analyzing, interpreting and presenting clinical quality-related data. + Previous case review experience. **Preferred… more
- Stanford Health Care (Palo Alto, CA)
- …improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection; ... payers to assure reimbursement for patient services/procedures. Communicates with review organizations/payers to provide requested clinical and psychosocial… more
- HCA Healthcare (Riverside, CA)
- …database to ensure adequate documentation as required by regulatory agencies. + Complete concurrent review of cases to identify quality, timelines and systems of ... and Patient Safety (PIPS) Program. The PI Coordinator will review the continuum of care to determine compliance with...The Trauma Performance Improvement RN Coordinator is a registered nurse with in-depth knowledge of the clinical … more
- Stanford Health Care (Palo Alto, CA)
- …improvement activities by identifying opportunities forimprovement in such areas as clinical outcomes, utilization of resources and concurrent data ... clinical and psychosocial information to assurereimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all inpatients… more