- 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
- 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
- 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
- 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
- The County of Los Angeles (Los Angeles, CA)
- …work at the direction of a rehabilitation therapist, social worker, or registered nurse . Incumbents are typically responsible for providing technical direction ... line operation responsible for the delivery of psychological rehabilitation, case management and/or Psychiatric Emergency Service of the Department of Mental Health… more
- The County of Los Angeles (Los Angeles, CA)
- …work at the direction of a rehabilitation therapist, social worker, or registered nurse . Incumbents are typically responsible for providing technical direction ... to a line operation responsible for delivering psychological rehabilitation, case management , and/or psychiatric emergency services in the Department of Mental… more
- Elevance Health (Los Angeles, CA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Location:** This role enables associates...required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines is preferred + ICD-9… more
- Evolent (Sacramento, CA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- Fresenius Medical Center (Anaheim, CA)
- …for the overall control of planning, staffing, budgeting, expense priority management , and recommendation and implementation changes of current methods. + ... Review and comply with the Code of Business Conduct...for improvement eg Compliance, Billing, and Quality Indicators. + Utilization of data to better understand their business unit(s)… more
- Elevance Health (Costa Mesa, CA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Sign on Bonus: $5000.**...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more