- Providence (Mission Hills, CA)
- **Description** ** RN Utilization Review - Remote. This position will work full- time in a 8-hr Day shift.** Provide prospective, retrospective, and ... Management , medical necessity, and patient status determination. The Utilization Management RN must effectively...**Required Qualifications:** + Associate's Degree in Nursing. + California Registered Nurse License upon hire. + 2… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... Requirement :** **Minimum Experience Requirement :** Minimum of three years of utilization management experience. Experience in quality- related job preferred.… more
- Actalent (Rancho Cordova, CA)
- Utilization Review Nurse About the...Identify care coordination needs and refer cases to case management as appropriate Qualifications + Active CA RN ... Role We're looking for a Utilization Review (UR) Nurse to join our team...2-3 years of clinical experience in prior authorization, case management , or utilization management +… more
- TEKsystems (Los Angeles, CA)
- …for a Licensed Vocational Nurse (LVN) or Registered Nurse ( RN ) with hands-on experience in Utilization Management (UM) and a strong understanding ... Location: West Hills/Canoga Park 91305 Compensation: LVN $38-$40 hourly RN $45-$50 hourly Overview: The Retro Claims Reviewer... license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with… more
- Sharp HealthCare (La Mesa, CA)
- …3 Years Recent acute care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA Board of Registered Nursing ... Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA...the department head as indicated. + Utilization review and utilization managementThe RN … 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
- Elevance Health (Los Angeles, CA)
- ** Nurse Reviewer I** **Location:** This role...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... Monday - Friday (9:30 AM -6:00 PM Centeral) The ** Nurse Reviewer I** is responsible for conducting...required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines is preferred + ICD-9… 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
- Select Medical (San Diego, CA)
- …functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, ... Friday 8-5pm** **$10,000 Sign On Bonus** **Salary: $135-155,000** **_Clinical license as a registered nurse or respiratory therapist or master's in social work… 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