- Providence (Santa Rosa, CA)
- …with management, medical staff and medical center personnel. Provides payor/utilization review organizations with concurrent retrospective utilization review ... throughout their admission to ensure the availability of sufficient clinical and medical center resources. Communicates on a daily...due within 90 days of hire. + Coursework/Training: General Nurse Competency due within 30 days of hire. +… more
- Elevance Health (Los Angeles, CA)
- … clinical staff. + Conducts and may approve pre-certification, concurrent , retrospective, out of network and/or appropriateness of treatment setting reviews ... not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians...equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. +… more
- Prime Healthcare (Chino, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top...accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum… more
- BrightSpring Health Services (North Highlands, CA)
- …Registered Professional Nurse + Excellent communicator with ability to handle concurrent tasks and responsibilities + Ability to travel within assigned area + ... monitoring both skilled and non-skilled healthcare services + Directly supervises clinical personnel + Providing clinical teaching and conducting performance… more
- Magellan Health Services (San Diego, CA)
- …person-centered care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care ... members in the Medicaid, Medicare, and Whole Health markets. Possesses clinical knowledge, understands best practices and continuous learning skills, reviews member… more
- Actalent (Sacramento, CA)
- Utilization Review Nurse (LVN) - InpatientPrimary Responsibilities + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and ... Working knowledge of EZ-CAP, EZ-Net, InterQual, and MCG preferred. + Background in concurrent review or inpatient census oversight preferred. + Strong critical… more
- Prime Healthcare (La Palma, 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 (San Dimas, 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
- Cedars-Sinai (Beverly Hills, CA)
- …by assessing their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered ... as necessary. + Plans for discharges and care assessments. + Submits necessary clinical information to the health plan using the accepted format and coordinate… more