- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- Sutter Health (Roseville, CA)
- …SMCS-Valley Administration **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the ... and at the appropriate level of care. Coordinates the utilization management , resource management , discharge...+ Bachelor's in Nursing preferred. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon… more
- Dignity Health (Rancho Cordova, CA)
- …working knowledge of Utilization Management Working knowledge of the Utilization Management review processes, and regulatory requirements. Must have ... and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for...or experience equivalent required. - Clear and current CA Registered Nurse ( RN ) license. -… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse - Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position ... medical record review for Payment Integrity and Utilization Management projects. The position serves as...Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Molina Healthcare (Los Angeles, CA)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 DAY SHIFT 7:30AM - 08:30PM PACIFIC HOURS NON EXEMPT, 3 days a week will… more
- VNA Health (Santa Barbara, CA)
- …in clinical education, inservice and nursing staff meetings. + Participate in Quality Management and Utilization Review Activities. + Maintain necessary ... - Friday; 8 Hour Shifts 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
- Sutter Health (Goleta, CA)
- …- Santa Barbara **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's accepted ... 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
- CVS Health (Sacramento, CA)
- …work._ **Required Qualifications** + 1 year of varied UM ( utilization management ) experience within an **outpatient** setting, concurrent review or prior ... make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted...+ 1 year of varied UM ( utilization management ) experience within an inpatient, concurrent review … more
- Fresenius Medical Center (San Bernardino, 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 loss review . * Responsible for all required network reporting and on-site state… more
- Fresenius Medical Center (Moreno Valley, 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