- Sedgwick (Sacramento, CA)
- …(10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control. **Skills & ... the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim denial, disability...+ Knowledge of ADAA and FMLA + Knowledge of utilization review procedures + Knowledge of clinical… more
- Sharp HealthCare (San Diego, CA)
- …when not in use.Is knowledgeable of current laws and regulations regarding Utilization Review and Discharge Planning.Morning arrival time insures orderly ... + Data collectionParticipates in data and statistics collection as requested by Utilization Review , Service Line and Quality Improvement Committees. + Denial… more
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... Management issues; other issues including concerns involving under/over utilization , avoidable days and quality issues. Coordinate daily with interdisciplinary… more
- The County of Los Angeles (Los Angeles, CA)
- …scope of practice. + Participates in the development, negotiation, implementation, and management of the budget for the program support service operations, clinic, ... and implements reporting procedures to ensure that program services utilization and revenue data are reported accurately and in...of care and establishes and modifies program monitoring and review methods as necessary. + Oversees audits and the… more
- Sutter Health (Tracy, CA)
- …STCH-Sutter Tracy Community Hosp **Position Overview:** Provides leadership and management support in planning, organizing, staffing and controlling the operational ... to direct facility operations, and supervises personnel in all departments when leadership/ management staff is not present in the facility. During that time, serves… more
- STG International (Corona, CA)
- …in quality improvement, care management , risk management , peer review , utilization review , clinical outcomes, and health enhancement activates. ... in the orientation of clinical staff physicians, physician assistants and nurse practitioners. *Provide leadership to CBOC clinicians. *Evaluate the effectiveness of… more
- HCA Healthcare (Riverside, CA)
- …+ Registered Nurse (RN) with current California license required, Case Management Certification or utilization review preferred + Associate's Degree ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...be an evening shift position. The Coordinator of Case Management (RN CM) is responsible for promoting patient-centered care… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... Sterile Product Certification) - Various-Employee provides certificate; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric… more
- Veterans Affairs, Veterans Health Administration (Santa Rosa, CA)
- …Scopes of Practice: The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization ... AMSA works with multiple Integrative Health providers, including physicians, registered nurse care managers, mental health providers, and allied integrative health… more
- Elevance Health (Los Angeles, CA)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians...initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes.… more