- CVS Health (Sacramento, CA)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.** -OR- OPTION II:… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print...over the nursing staff engaged in utilization review activities at Los Angeles General Medical ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 - $177,314.88 Annually… 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 awareness ... develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices,… 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 ... Schedule:** Full time **Job Shift:** Day **Career Track:** Nursing **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work… more
- Dignity Health (Woodland, CA)
- …Woodland, CA, with occasional onsite meetings in Woodland.** **Position Summary:** The Utilization Review LVN uses clinical judgement in providing utilization ... - Preps case thoroughly, concisely and clearly for physician review . Researches EMR, criteria, medical policy and...nursing requirements in a clinical setting. - Knowledge of utilization management programs as related to pre-set protocols and… more
- Emanate Health (Covina, CA)
- …the United States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical … more
- Centene Corporation (Sacramento, CA)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Prime Healthcare (Ontario, CA)
- …working for a Health Plan. + At least 3 years of experience in utilization review , referrals, authorizations, denials and appeals. + Current BCLS (AHA) ... of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity,… more
- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/219588/*case-manager%2c-rn utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service… more