- UCLA Health (Los Angeles, CA)
- …+ experience in an HMO environment + Thorough knowledge of health care industry, utilization review , utilization management , and concurrent review ... at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management...following major functions: + Pre-service Authorizations/Denial Letters + Concurrent Review + Continuity of Care + Retro Claims +… more
- Alameda Health System (San Leandro, CA)
- Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA + John George Psychiatric Hospital + JGP Care Coordination + ... EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review ,...Department). Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State ofCalifornia.\ Pay… more
- Sutter Health (San Francisco, CA)
- …Med Center Davies **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's ... and at the appropriate level of care. Coordinates the utilization management , resource management , discharge...an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California +… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based ... to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards,...+ A minimum of three years of experience in utilization management , preferred + Team leading or… more
- Cognizant (Sacramento, CA)
- …have to be considered** + Educational background - Registered Nurse ( RN ) + 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- Ventura County (Ventura, CA)
- …the Senior Medical Management Nurse is responsible for performing utilization review , case management , and quality improvement functions to ensure ... in Case Management , Disease Management , Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must possess and maintain a… more
- VNA Health (Santa Barbara, CA)
- …in clinical education, inservice and nursing staff meetings. + Participate in Quality Management and Utilization Review Activities. + Maintain necessary ... Schedule: 3 days/week, 12 hours/day Job Description: The Inpatient Registered Nurse provides hospice care and is...and families in the General Inpatient setting. The Inpatient RN fully supports the Core Values and is accountable… more
- Sharp HealthCare (San Diego, CA)
- …case management experience. + 3 Years case management , utilization review , care coordination experience. + California Registered Nurse ( RN ) - ... Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA...the department head as indicated. + Utilization review and utilization managementThe RN … more
- Rady Children's Hospital San Diego (San Diego, CA)
- …Degree in Nursing 4 years nursing in an acute hospital or 2 years Case Management , Utilization Review , or Discharge Planning experience in an acute hospital ... coordinating discharge needs, quality of care, and implementing the utilization management process for acute inpatients. Case... process for acute inpatients. Case Managers perform concurrent review and denials management based on acute… more
- Fresenius Medical Center (Colton, CA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more