- Sharp HealthCare (San Diego, CA)
- …not medically necessary and/or not covered benefit and refer to Utilization Review Committee. Ensures that all denials for medical necessity are issued under ... be unrestricted. **Essential Functions** + Referral CoordinationEnsures consistent application of the utilization review process for effective utilization of… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure… 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, ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/219949/case-manager-%28rn%29 utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityChino Valley … 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, ... Paid time off + 401K retirement plan + Outstanding Medical + Dental + Vision coverage + Tuition reimbursement...accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum… more
- Centene Corporation (Sacramento, CA)
- …on member medical records in health management systems according to utilization management policies and guidelines + Works with healthcare providers to approve ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Centene Corporation (Sacramento, CA)
- …with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against guidelines and ... of care issues, and if identified, refer to the Medical Director or provider for review and...guidelines + Assists with providing education to providers on utilization processes to promote high quality, cost-effective, and efficient… more
- Ventura County (Ventura, CA)
- …in-services and staff development programs; + May participate in quality assurance/ utilization review or other non-direct patient care nursing assignments; ... Registered Nurse II - Medical Surgical and...number of qualified applications to meet business needs. FIRST REVIEW OF APPLICATIONS: May 29, 2025 Examples Of Duties… more
- Ventura County (Ventura, CA)
- …in-services and staff development programs; + May participate in quality assurance/ utilization review or other non-direct patient care nursing assignments; ... Medical Surgical and Telemetry Registered Nurse II - Float Pool -Regular and Per Diem Print… more
- LA Care Health Plan (Los Angeles, CA)
- …such as ambulatory care, home care, palliative care, hospice care OR experience in Utilization Review or Care Management will be considered in lieu of direct ... comorbidities, and/or disabilities in a UM/CM environment. Preferred: Experience in utilization review , skilled nursing, home health, discharge planning,… more
- LA Care Health Plan (Los Angeles, CA)
- …policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position ... Payment Integrity Nurse Coder RN III Job Category: Clinical Department:...inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal… more