- 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
- Elevance Health (Costa Mesa, CA)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- LA Care Health Plan (Los Angeles, CA)
- …case management referrals (5%) Performs prospective, concurrent, post-service, and retrospective claim medical review processes. Utilizes clinical judgement, ... requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted… more
- Elevance Health (Costa Mesa, CA)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Sutter Health (Oakland, CA)
- …an accredited school of nursing Required + BSN Preferred **CERTIFICATION & LICENSURE** + RN - Registered Nurse of California Required + Certified Case Manager ... 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 (Modesto, CA)
- …**EDUCATION:** 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
- Sedgwick (Sacramento, CA)
- …Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior medical -set-aside experience highly desired for this ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
- The County of Los Angeles (Los Angeles, CA)
- …mental health team. Option III : A valid, current license to practice as a registered nurse issued by the appropriate State of California licensing agency -AND- ... of care and establishes and modifies program monitoring and review methods as necessary. + Oversees audits and the...have a valid, current license to practice as a registered nurse issued by the appropriate State… more
- The County of Los Angeles (Los Angeles, CA)
- …Evaluator, Nursing** -OR- Option II: One year of work experience* as a registered nurse enforcing local licensing and certification requirements relating to ... assigned to a district office, providing technical and administrative review of reports submitted pertaining to areas affecting the...Certificate(s) Required: A current license to practice as a Registered Nurse issued by the California Board… more
- The County of Los Angeles (Los Angeles, CA)
- …as a nursing instructor* or an equivalent . -AND- A license to practice as a Registered Nurse issued by the California Board of Registered Nursing. LICENSE ... compete in this examination process, applicants must have a license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
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