- John Muir Health (Walnut Creek, CA)
- …the nursing practice with specialized focus on care coordination, compliance, transition management , education, and utilization management . **Education:** + ... manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager ...Support - American Heart AssociationRequired + ACM Accredited Case Manager - ACMA American Case Management Association… more
- Elevance Health (CA)
- **Behavioral Health Care Manager I, Utilization Management ** **Work Hours M-F 8am-5pm PST** **Work Location: Virtual, California** This role enables ... granted as required by law. The **Behavioral Health Care Manager I, Utilization Management ** is...will make a difference:** + Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to… more
- Prime Healthcare (Montclair, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/242252/case- manager -%28rn%29 utilization - ... preferred, and community focused. Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from the… more
- Cedars-Sinai (Los Angeles, CA)
- …Utilization Review Case Manager - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical Center **Job Category** : ... named us one of America's Best Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent… more
- LA Care Health Plan (Los Angeles, CA)
- … of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management (CM). Knowledge of Department of Health ... Utilization Management Nurse Specialist RN II...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Prime Healthcare (Sherman Oaks, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/239073/case- manager - utilization - management ... or management , preferred. + Current BCLS certificate preferred. + Knowledge of Milliman Criteria and InterQual Criteria preferred. Pay Transparency Sherman Oaks… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/237903/rn-case- manager utilization ... year experience in case management , discharge planning or nursing management , preferred.4. Current BCLS (AHA) certificate, preferred.5. Knowledge of Milliman… more
- CenterWell (Sacramento, CA)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- Sharp HealthCare (San Diego, CA)
- …care, SNF, home health, or hospice settings. + Experience as a case manager or discharge planner interacting with managed care payers. + Experience with InterQual ... departmental guidelines during hospital stay beginning with the admission review of the case manager and reviews with the Case Manager Lead, as needed.Keeps SRS… more
- Dignity Health (Red Bluff, CA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... five (5) years of nursing experience. + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more