- University of Southern California (Glendale, CA)
- …PRO regulations, JCAHO standards and contractual agreements with insurers or outside review agencies. Minimum Education: Current RN license in the State ... of California, BSN preferred Minimum Experience/Knowledge: Recent experience in Utilization /Quality/ Case Management in acute setting preferred Required… 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 care. ... documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established… more
- Stanford Health Care (Palo Alto, CA)
- …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- Stanford Health Care (Palo Alto, CA)
- …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- CenterWell (San Diego, CA)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Sharp HealthCare (San Diego, CA)
- …BBS Licensed Marriage and Family Therapist (LMFT) - CA Board of Behavioral Sciences; California Registered Nurse ( RN ) - CA Board of Registered Nursing ... BLS Healthcare) - American Heart Association -REQUIRED + California Registered Nurse ( RN ) - CA...in use.Is knowledgeable of current laws and regulations regarding Utilization Review and Discharge Planning.Morning arrival time… more
- Insight Global (Los Angeles, CA)
- …2+ years in a lead or supervisor role EMR system experience valid California Registered Nurse ( RN ) license Current Basic Cardiac Life Support (BLS/CPR) ... Job Description Insight Global is seeking a skilled Registered Nurse Supervisor for a community...medical practice is preferred. Experience in chronic disease management, case management, utilization management and quality improvement… more
- Sutter Health (Oakland, CA)
- …+ BSN Preferred **CERTIFICATION & LICENSURE** + RN - Registered Nurse of California Required + Certified Case Manager (CCM) Preferred. **EXPERIENCE** ... case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of… more
- LA Care Health Plan (Los Angeles, CA)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals &...clinical appeals and grievances experience in a managed care, utilization management and/or case management setting, At… more
- Dignity Health (Rancho Cordova, CA)
- … Case Manager role. - Associates of Nursing degree. - Clear and current CA Registered Nurse ( RN ) license. - Comprehensive knowledge of care management and ... efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality… more
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