- Molina Healthcare (Los Angeles, CA)
- California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_3-12 DAY SHIFT 7:30AM - 08:30PM PACIFIC HOURS NON EXEMPT, 3 days a week will ... experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. **Preferred… more
- Prime Healthcare (Lynwood, CA)
- …effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service ... Connect 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) FacilitySt. Francis Medical… 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 work ... Full time **Job Shift:** Day **Career Track:** Nursing **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work Location:** Queen of the… more
- Sedgwick (San Francisco, CA)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Senior Estimate Review Specialist **PRIMARY PURPOSE** **:** To review all estimates and ... supporting documentation submitted by contractors/adjusters, using various estimating applications; to ensure estimates follow client and regulatory requirements and meet Property guidelines; to serve as a subject matter expert on property restoration scope.… more
- Ventura County (Ventura, CA)
- …for the leadership and direction in planning, and coordinating medical reviewer staff to ensure appropriate, professional, and cost-conscious inpatient and ... TENTATIVE TIMELINE OPENING DATE: May 09, 2025 CLOSING DATE: Continuous FIRST REVIEW OF RESUMES: Week of May 26, 2025 Examples Of Duties Duties… more
- Sharp HealthCare (San Diego, CA)
- …achieve selected utilization/cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations. + Participates in the ... retrospective review and analysis of Plan performance from summary data...process for identifying Potential Quality Issues. + Supervises Physician Reviewer (s) + Shares after-hours coverage responsibilities with other physicians… more
- San Diego Community College District (San Diego, CA)
- …Until Filled No Classification Title INTERDISCIPLINARY BASIC SKILLS-English Review |CBEST: Adjunct/Substitute Instructor POOL (non-credit) Working Title Adjunct ... Faculty Recruitment Limits Location District Wide Pay Information At the time that an offer of assignment is made, proper salary placement is contingent upon receipt of OFFICIAL (sealed) transcripts and Verifications of Previous Work Experience (if… more
- Trinity Health (Fresno, CA)
- **Employment Type:** Full time **Shift:** **Description:** This position coordinates utilization review service for defined patient populations across the acute care ... continuum. This includes discharge planning, utilization management, care coordination collaboration, and support for resource utilization. This position works collaboratively with an interdisciplinary team to improve patient care through the effective… more
- UCLA Health (Los Angeles, CA)
- …inspections of clinical areas, patient care practices, and administrative processes + Review medical records of services in preparation for health plan and/or ... regulatory audits for medical appropriateness by using established clinical protocols and health plan resource tools + Assess compliance with healthcare regulations, accreditation standards, and organizational policies + Extrapolate and prepare a detailed,… more
- MUFG (Los Angeles, CA)
- …portfolios to identify deterioration or negative management control trends and review compliance with policies, guidelines, and regulations. + Prepare periodic Risk ... Profile & Monitoring Plans to outline key risk factors and allocate appropriate resources. + Analyze individual credits and/or credit relationships for quality, adherence to approval conditions, the accuracy of risk grading, and adequacy and accuracy of… more