- Datavant (Sacramento, CA)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Amergis (Orange, CA)
- …as those listed above may also be qualifying. Preferred Qualifications: + Utilization management reviewer experience. + Managed care experience. + Behavioral ... help support a health insurance agency! The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for… 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 ... for monitoring the delivery of patient care through the utilization of the nursing process, physicians' orders, established policies...of nursing; BSN desired, MSN preferred. + Current California Registered Nurse License. + Current BCLS and… more
- Highmark Health (Sacramento, CA)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- STG International (Corona, CA)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. ... patient safety. *Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health… 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 ... the electronic medical records of all patients contacted for review by the managing physician; Routinely staffs difficult cases... license; full, active, and unrestricted license as a Registered Nurse in one of any US… more
- Stanford Health Care (Palo Alto, CA)
- …. + CCDS - Cert Clinical Document Spec . + CCDS-O or CDIP . + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred ... + ICU/ED and Academic Medical Center experience preferred. + Case management, utilization review and/or direct provider interaction experience, preferred. +… 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 referral… 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 ... Clearance, or the ability to obtain a clearance. * Current RN license; full, active, and unrestricted license as a Registered Nurse in one of any US State,… 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 ... transition, including potential impact on data quality for prospective payments, utilization , and reimbursement. Knowledge of ICD-10 desirable. + Strong Organization… more