- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and...customer service skills required. **Minimum License Requirement :** California RN license. Delivering world-class health care one patient at… more
- TEKsystems (Canoga Park, CA)
- …Perform comprehensive utilization reviews for inpatient and outpatient claims . + Prepare medical records for review by medical directors and provide ... active license to join our team as a Utilization Review Nurse . In this role, you will...you will conduct retrospective reviews of inpatient and outpatient claims to ensure medical necessity, compliance, and… more
- The County of Los Angeles (Los Angeles, CA)
- …be active and unrestricted. Successful candidates are required to provide proof of their Registered Nurse ( RN ) License and Basic Life Support (BLS) ... REGISTERED NURSE I/RELIEF NURSE ...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… more
- 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: Two (2) years of experience as a registered nurse , of which one year must...may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN … more
- The County of Los Angeles (Los Angeles, CA)
- REGISTERED NURSE I, SHERIFF (CORRECTIONAL HEALTH) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2930992) Apply REGISTERED NURSE ... is currently offering up to 20% bonus for full-time Registered Nurse I, Sheriff positions hired by...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… more
- Cognizant (Sacramento, CA)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical ...CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board… more
- Sutter Health (Burlingame, CA)
- …: **EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire CCM certification ... position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to...services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
- Sutter Health (San Francisco, CA)
- …+ Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** + ... position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to...services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
- CVS Health (Sacramento, CA)
- …however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating ... all case management activities with members to evaluate the medical needs of the member and to help facilitate...- Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more