- 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 of ... Location: West Hills/Canoga Park 91305 Compensation: LVN $38-$40 hourly RN $45-$50 hourly Overview: The Retro Claims Reviewer is...provider and member claims for accuracy and compliance + Review and process claims in accordance with UM guidelines… more
- Deloitte (Los Angeles, CA)
- …degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical Documentation Specialist - CCDS (inpatient) ... registered nurse , physician, physician assistant, case manager, clinical documentation specialist , utilization review , informatics RN , Quality,… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Cedars-Sinai (CA)
- …for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to ... as a condition of continued employment. **Req ID** : 13443 **Working Title** : Registered Nurse Care Coordinator- Inpatient Specialty Program - 8 Hour Days $5K… more
- Sharp HealthCare (San Diego, CA)
- …in Patient Safety (CPPS) - Certification Board for Professionals in Patient Safety; California Registered Nurse ( RN ) - CA Board of Registered ... Will Do** The purpose of the Sr. Performance Improvement Specialist is to improve clinical outcomes including responsibilities relating...Board for Professionals in Patient Safety -PREFERRED + California Registered Nurse ( RN ) - CA… more
- LA Care Health Plan (Los Angeles, CA)
- …of Microsoft Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Payment Integrity Nurse Coder RN III Job Category:...policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management… more
- 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...Integrate research and evidence based practice into the development, review and revision of patient education materials. Identifies and… more
- LA Care Health Plan (Los Angeles, CA)
- …Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse ( RN );current and unrestricted California ... Care Management Specialist II Job Category: Clinical Department: Care Management...health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims… more
- University of Southern California (Arcadia, CA)
- …requirements impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review /case management in an ... and other clinical staff. + Meets established productivity targets for record review and appropriate query placement. + Demonstrates working knowledge of ICD-10 CM… more
- Stanford Health Care (Palo Alto, CA)
- …Lead APP also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), ... and adherence to policy through practice analysis and case review of APPs with physicians. . Investigate and respond...under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered … more