- Sharp HealthCare (San Diego, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) ... requires the ability to combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the… more
- Stanford Health Care (Palo Alto, CA)
- …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. Case Managers act as consultants to the clinical… more
- Dignity Health (San Luis Obispo, CA)
- …experience, efficiency, FMEAS, root cause analyses and medical staff improvement (eg case review for peer review , OPPE, FPPE). + Participates in an integral ... duties as assigned. **Qualifications** **Education and Experience:** + Licensed Registered Nurse , Licensed Clinical Pharmacist, or other Licensed Clinical Staff and… more
- Centene Corporation (Sacramento, CA)
- …weight, current and past medical history, clinical laboratory results and concurrent medications (including over-the-counter or home remedy medications) + Ensure ... and the results are obtained and discussed with the nurse and the physician + Provide patient counseling, education,...+ Assess responses to therapy, patient compliance, and ongoing review of drug regimens; report and manage adverse events… more
- Providence (Santa Rosa, CA)
- …with management, medical staff and medical center personnel. Provides payor/utilization review organizations with concurrent retrospective utilization review ... due within 90 days of hire. + Coursework/Training: General Nurse Competency due within 30 days of hire. +...due within 30 days of hire. + California Registered Nurse License upon hire. + 3 years acute nursing… more
- Sharp HealthCare (San Diego, CA)
- …an effective in-patient Care Management program that includes initial and concurrent review ; case management/discharge planning activities. Responsible for ... 1 **Shift Start Time** **Shift End Time** California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's...preferably in a managed care setting + California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED… more
- Actalent (Sacramento, CA)
- Utilization Review Nurse (LVN) - InpatientPrimary Responsibilities + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and ... of EZ-CAP, EZ-Net, InterQual, and MCG preferred. + Background in concurrent review or inpatient census oversight preferred. + Strong critical thinking,… more
- Elevance Health (Los Angeles, CA)
- …complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians **How you will make an impact:** ... guidelines within scope of licensure. + These reviews may require in-depth review ; however, any deviation from application of benefits plans will require guidance… 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
- 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 ... health plan communication with assigned hospitalist as appropriate. + Coordinates with Nurse Practitioners and ISP Hospitalists assigned to the SNF's for continued … more