- 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 in ... System Utilization Management SUM Specialist + Oakland,...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity… more
- Cedars-Sinai (Los Angeles, CA)
- …Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of Joint ... for Hiring. **Req ID** : 10457 **Working Title** : Registered Nurse - Clinical Documentation Specialist - 8 Hour Days **Department** : CSMC 8700011 CSRC CDI… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- LA Care Health Plan (Los Angeles, CA)
- …and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The ... Registered Nurse - Payment Integrity Nurse Coder...inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to… more
- Alameda Health System (Oakland, CA)
- …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... Care Management Specialist + Oakland, CA + Highland General Hospital...the direction of the Care Management social worker and/or nurse , facilitates, identifies and documents all referrals made to… more
- Stanford Health Care (Palo Alto, CA)
- …professional growth and development of their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified ... and adherence to policy through practice analysis and case review of APPs with physicians. + Investigate and respond...experience as a licensed advanced practice provider: (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist … more
- STG International (Corona, CA)
- …patient safety. *Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health ... Quality Performance Improvement Team (QPIT) strategic initiatives. *Participate in review and improvement of clinical success in of areas...Corps - 60J, 60L, 61F, 61H, 61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse … more
- UCLA Health (Los Angeles, CA)
- …+ Communication and coordination of patient care with heart failure nurse specialist , transplant cardiologist, inpatient team members, heart transplant ... coordinators, cardiac surgeons, bed control, admissions, case managers, and utilization review . + Assisting the Cardiomyopathy Administrative Supervisor with… more