- Cedars-Sinai (CA)
- …for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to ... as a condition of continued employment. **Req ID** : 13443 **Working Title** : Registered Nurse Care Coordinator- Inpatient Specialty Program - 8 Hour Days $5K… more
- CVS Health (Sacramento, CA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Elevance Health (Costa Mesa, CA)
- ** Telephonic Nurse Case Manager II** **Sign on Bonus: $2000.** **Location: Virtual: This role enables associates to work virtually full-time, with the exception ... members in different states; therefore, Multi-State Licensure will be required.** The ** Telephonic Nurse Case Manager II** is responsible for care management… more
- LA Care Health Plan (Los Angeles, CA)
- …requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Utilization Management Nurse Specialist RN...Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review ,… more
- Cedars-Sinai (CA)
- …the established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review ... Hospitals! **What You Will Do in This Role:** A Registered Nurse Case Manager plans and coordinates...in Nursing (preferred). **Certifications/Licenses:** + Current and valid California RN License (required). + Certified Case Manager (CCM) or… more
- Cedars-Sinai (Marina Del Rey, CA)
- …the established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review ... Bonus **What You Will Do in This Role:** A Registered Nurse Case Manager plans and coordinates...in Nursing (preferred). **Certifications/Licenses:** + Current and valid California RN License (required). + Certified Case Manager (CCM) or… more
- Stanford Health Care (Palo Alto, CA)
- …to identify trends and make recommendations for improvement. **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... + Reduce avoidable inpatient and SNF bed days through telephonic & in person concurrent review , proactive...to deal with technical queries. + Demonstrated ability to review utilization reports and data. + Ability… more
- Elevance Health (CA)
- …substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review . **How you will make a ... **Behavioral Health Care Manager I, Utilization Management** **Work Hours M-F 8am-5pm PST** **Work...background. + Current active unrestricted **California** license, such as RN LCSW LMHC LPC LMFT or Clinical Psychologist to… more
- University of Southern California (Los Angeles, CA)
- …+ Pref 2 years Experience in an HMO/IPA/Managed care setting Required Licenses/Certifications: + Req Registered Nurse - RN (CA DCA) + Req Basic Life Support ... + Req 5 years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the last three years + Req Ability to work… more
- Ventura County (Ventura, CA)
- …direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, and quality improvement functions to ensure ... the link below: CNA_MOA_2023-2028.pdf (ventura.org) (https://vcportal.ventura.org/CEO/HR/MOA/docs/CNA\_MOA\_2023-2028.pdf) PAYROLL TITLE: Senior Registered Nurse - Ambulatory Care DISTINGUISHING CHARACTERISTICS:… more