- Evolent (Sacramento, CA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- Elevance Health (Costa Mesa, CA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: Virtual: This role...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Cedars-Sinai (Los Angeles, CA)
- …required Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of ... **Job Description** Are you ready to bring your advanced Health Information Management skills to a world-class facility recognized as one of the top ten in the… more
- VNA Health (Santa Barbara, CA)
- …a $5,000 sign on BONUS! Job Description: VNA Health is looking for compassionate Registered Nurse Case Managers (RN CM) to join our Home Health care team. The RN CM ... organizes and directs home care services. Responsibilities: + Responsible for continuous review of all aspects of every patient on his/her caseload to include:… more
- Fresenius Medical Center (San Bernardino, CA)
- …auditing activities. *Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. *Manages clinic financials ... including efficient utilization of supplies or equipment and regular profits and loss review . * Responsible for all required network reporting and on-site state… more
- Humana (Sacramento, CA)
- …leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director… more
- Dignity Health (Rancho Cordova, CA)
- …working knowledge of Utilization Management Working knowledge of the Utilization Management review processes, and regulatory requirements. Must have ... the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of… more
- Molina Healthcare (Los Angeles, CA)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 DAY SHIFT 7:30AM - 08:30PM PACIFIC HOURS NON EXEMPT, 3 days a week will… more
- Dignity Health (Bakersfield, CA)
- …as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the ... The position partners with both the Pre-Service and In-Patient Utilization Management teams. Ensures to monitor and...external customer. - Perform all functions of the UM nurse reviewer . - Composes denial letter in… more
- Dignity Health (Bakersfield, CA)
- …as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the ... The position partners with both the Pre-Service and In-Patient Utilization Management teams. Ensures to monitor and...- Ensures that there is evidence that the UM nurse reviewer documented communications with the requesting… more