- 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 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- TEKsystems (Los Angeles, CA)
- …Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes. ... LVN or RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with HMO/Medicare claims, audits, and denials +… more
- University of Southern California (Los Angeles, CA)
- The Clinical Nurse Specialist serves as a resource/consultant for all departments regarding clinical specialty, conducts/ participates in research across varied ... Essential Duties: + Consultant Clinical resource with staff on management of complex cases. Makes rounds for the purposes...the hospital and community. Facilitates the training of clinical nurse specialist students and other nursing students… more
- LA Care Health Plan (Los Angeles, CA)
- Care Management Specialist II Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ... required to achieve that purpose. Job Summary The Care Management Specialist II utilizes clinical skills and...Case Manager (CCM) Accredited Case Manager (ACM) Certification Case Management Nurse - Board Certified (CMGT-BC) Required… more
- Alameda Health System (San Leandro, CA)
- SLH Care Management Specialist + San Leandro, CA + San...years in a health care field or one year in Utilization Management at a Medical Group or 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
- Edwards Lifesciences (San Francisco, CA)
- …difference to patients around the world. As a part of the Field Clinical Specialist team, you will be a critical part of delivering our patient focused innovations, ... Quality, Regulatory, and Education. After extensive training, a Field Clinical Specialist will travel frequently within an assigned territory, clinically training… more
- Sharp HealthCare (San Diego, CA)
- …Association for Healthcare Quality; Certified Professional in Healthcare Risk Management (CPHRM) - American Hospital Association; Certified Professional in Patient ... (CPPS) - Certification Board for Professionals in Patient Safety; California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree **Hours**… more
- Deloitte (Los Angeles, CA)
- … nurse , physician, physician assistant, case manager, clinical documentation specialist , utilization review, informatics RN, Quality, DRG Validation and ... Current Registered Nurse (RN) license required + Certified Clinical Documentation Specialist - CCDS (inpatient) certification required. + A minimum of 3 years of… more
- Philips (San Diego, CA)
- …+ Ability to effectively manage assigned accounts in terms of driving utilization , customer relationship management , problem resolution, etc. + You must ... **Sales Support, Clinical Specialist - FORS (West/National Travel)** In this role...with clinical experience as Radiologic Technologist (RT) or Registered Nurse (RN) highly preferred. + Experience in healthcare (in… more
- LA Care Health Plan (Los Angeles, CA)
- …the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter ... can include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management , Medical Directors, and other internal teams to… more