- Sutter Health (Goleta, CA)
- …+ Other: Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California + CCM - Certified Case Manager ... Santa Barbara **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's accepted criteria for… more
- LA Care Health Plan (Los Angeles, CA)
- …Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse ( RN ); current and unrestrited California License. ... care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and Support (MLTSS), Social Services,… more
- UCLA Health (Los Angeles, CA)
- …- $341,800/annually Qualifications We're seeking an experienced leader with: + A Registered Nurse License, Advanced Practice Provider ( Nurse Practitioner ... programs and medical services with an emphasis on optimizing Utilization Management for the Faculty Practice Group (FPG) Management...+ 3-5 years of experience in a clinical capacity ( RN , APP, etc.), required + 3-5 years of executive… more
- Banner Health (Susanville, CA)
- …This position provides nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the quality ... 2. Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing...Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process… more
- Elevance Health (CA)
- …on relatively complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior clinicians. **How you will ... improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… more
- Veterans Affairs, Veterans Health Administration (Santa Rosa, CA)
- …programs. The AMSA works with multiple Integrative Health providers, including physicians, registered nurse care managers, mental health providers, and allied ... with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization...primary scheduler for the Integrative Health Service, coordinating with RN Care Managers and clinic providers to ensure patients… more
- Magellan Health Services (San Diego, CA)
- …Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... is required for this role with necessary degrees, LMSW, LCSW, LPC, or RN . Minimum 5 years experience post degree in healthcare, behavioral health, psychiatric and/or… more
- Alameda Health System (Oakland, CA)
- …is required. + Preferred Experience: N/A Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California or valid license as ... manages the collection, analysis and presentation data relevant to the utilization of healthcare resources, including but not limited to avoidable/variance days,… more
- Humana (Sacramento, CA)
- …in Nursing (BSN) or Bachelor's degree in any field or equivalent experience + Active unrestricted Registered Nurse ( RN ) license + 5 years or more of prior ... Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy Adoption (MCPA) + Perform… more
- Sutter Health (San Francisco, CA)
- …Other: Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE** RN - Registered Nurse of California BLS-Basic Life Support Healthcare ... manages capital and operational budgets to achieve financial targets via effective utilization of personnel, resources and supplies. Develops and maintains a solid… more