- LA Care Health Plan (Los Angeles, CA)
- …Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse ( RN );current and unrestricted California ... health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health Homes… more
- Humana (Sacramento, CA)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license, with no disciplinary action ... us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the...Health Provider Disputes based on the business need + Review and extract information from claims +… more
- Alameda Health System (Oakland, CA)
- …nursing background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Preferred ... Their responsibilities span from managing admissions to ensuring clean claims , identifying trends, and optimizing resource utilization. This role supports… more
- Elevance Health (Rancho Cordova, CA)
- **Telephonic Nurse Case Manager II** **Sign on Bonus: $5000.** **Location: This role enables associates to work virtually full-time, with the exception of required ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- UCLA Health (Los Angeles, CA)
- …outreach to support continuity of care and prevent avoidable hospitalizations. + Review and track claims , authorizations, and compliance with CMS regulations. ... and Intensive Case Management programs. Under the supervision of the RN Assistant Director, you will coordinate referrals, authorizations, and post-acute services,… more