- Select Medical (San Diego, CA)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, treatment plan… more
- Sharp HealthCare (San Diego, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... and guidelines.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- Sharp HealthCare (San Diego, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... policy.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- Alameda Health System (San Leandro, CA)
- …Required Experience: Three years in a health care field or one year in Utilization Management at a Medical Group or Health plan experience; electronic Health ... in-patient and post discharge services. + Per the direction of the Care Management social worker and/or nurse , facilitates, identifies and documents all… more
- Molina Healthcare (CA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- University of Southern California (Los Angeles, CA)
- …patient populations. The RN case manager role integrates the functions of utilization management , quality management , discharge planning assessment, and ... Pref Bachelor's Degree Nursing + Pref 1 year Case management or utilization review experience within the...last three years preferred. Required Licenses/Certifications: + Req Registered Nurse - RN (CA DCA) + Req Basic Life… more
- The County of Los Angeles (Los Angeles, CA)
- …used to fill a vacancy in Department of Health Services, Harbor-UCLA Medical Center, Utilization Management Division. May also be used to fill other vacancies ... + Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT INFORMATION:… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred Certified Case Manager (CCM) Accredited Case Manager (ACM) Certification Case Management Nurse - Board Certified (CMGT-BC) Required Training Physical ... Care Management Specialist II Job Category: Clinical Department: Care...health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health… more
- Stanford Health Care (Palo Alto, CA)
- …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... of services as well as appropriate utilization of services; and ensuring optimum use of resources,...delivery and quality of patient care. A hospital-based case management system has as its primary goal to ensure… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** As a Utilization Management RN, you will be crucial in ensuring accurate and compliant medical necessity decisions. Your ... for physician review. You'll work closely with both Pre-Service and In-Patient Utilization Management teams to ensure appropriate and cost-effective care. Key… more