- University of Southern California (Los Angeles, CA)
- …be obtained within 12 months of hire and maintain renewal. Required Licenses/Certifications: + Req Registered Nurse - RN (CA Board of Registered Nursing) ... The Clinical Nurse Specialist serves as a resource/consultant for all...Essential Duties: + Consultant Clinical resource with staff on management of complex cases. Makes rounds for the purposes… more
- KBR (San Diego, CA)
- …compliance in meeting care goals. * Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... license; full, active, and unrestricted license as a Registered Nurse in one of any US...by a recognized certifying organization, ie, Commission for Case Management Certification or American Nurse Credentialing Center.… more
- HCA Healthcare (Thousand Oaks, CA)
- …Care role today!** **Job Summary and Qualifications** The Clinical Nursing Manager is a registered nurse who reports directly to the unit Director or Chief ... review , direct observation, and other methods of quality management . **What qualifications you will need:** + Graduate from...of nursing; BSN desired, MSN preferred. + Current California Registered Nurse License. + Current BCLS and… more
- Evolent (Sacramento, CA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Sutter Health (San Mateo, CA)
- …+ Other: Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California + BLS-Basic Life Support Healthcare ... and assists in meeting financial targets by effectively managing utilization , productivity, personnel and supplies. Participates as necessary in...needs of the patients and to contribute to Quality Management review and evaluation. + Must have… more
- Highmark Health (Sacramento, CA)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Parexel (Sacramento, CA)
- …mitigations and drive resolution with cross-functional stakeholders as part of the Risk Management Plan. + Review and analyze metrics to derive meaningful ... practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable...project-level resourcing of staff and staff assignments. + Regularly review and update Data Management resources to… more
- Sutter Health (San Francisco, CA)
- …+ Master's in Healthcare (MPH, MHA, MS, MBA, etc.) **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California OR MD-Medical Doctor OR DO-Doctor of ... Documentation Integrity Practitioner **TYPICAL EXPERIENCE:** + 5 years recent management experience **SKILLS AND KNOWLEDGE:** + Knowledge of Pathophysiology and… more
- Elevance Health (Los Angeles, CA)
- …preferred. + BA/BS degree preferred. + Previous utilization and/or quality management and/or call center experience preferred. + RN Compact License is ... CST, with a comp day during the week) The ** Nurse Reviewer I** is responsible for conducting preauthorization, out...hospital setting or minimum of 1 year of prior utilization management , medical management and/or… more
- City and County of San Francisco (San Francisco, CA)
- …an accredited college or university AND LICENSE: Current, valid, unrestricted license as a Registered Nurse in the State of California AND EXPERIENCE: Four (4) ... staff, department heads, and NHA in matters related to nursing service 5. Review daily work assignments to ensure they meet regulatory compliance and provide… more