- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION II: ... UTILIZATION REVIEW NURSE SUPERVISOR...for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the… more
- 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)
- UTILIZATION REVIEW NURSE SUPERVISOR II...over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, ... Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 - $177,314.88… more
- Ventura County (Ventura, CA)
- …Under direction, scheduled as needed to assist with patient care coordination and utilization review . The incumbent will be responsible to assist with evaluation ... Per Diem Registered Nurse II/III - Utilization Management VCMC...is greater) AGENCY/DEPARTMENT: Health Care Agency - Ventura County Medical Center Per Diem Registered Nurse II/III… more
- CVS Health (Sacramento, CA)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible,...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating ... System Utilization Management SUM Utilization Review...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... 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
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- LA Care Health Plan (Los Angeles, CA)
- …referrals (5%) Performs prospective, concurrent, post-service, and retrospective claim medical review processes. Utilizes clinical judgement, independent ... admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests where determination requires… more
Recent Jobs
-
Occupational Therapist, Acute Rehab Center - Full Time Days
- St. Luke's University Health Network (Sellersville, PA)
-
Owner Operator OTR Class A Driver
- Clean Harbors (Cincinnati, OH)
-
Senior Plant Maintenance Technician
- WM (Detroit, MI)
-
Transplant Hepatology Physician
- HCA Healthcare (Denver, CO)