- Evolent (Sacramento, CA)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- VNA Health (Santa Barbara, CA)
- …in clinical education, inservice and nursing staff meetings. + Participate in Quality Management and Utilization Review Activities. + Maintain necessary ... - 7:30PM, 3 days per week, rotating weekends Job Description: The Inpatient Registered Nurse provides hospice care and is skilled at assessing pain and other complex… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …system and treatment methods, with specific knowledge and skills in areas of risk management , infection control, and utilization review . + Current knowledge ... and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Clinical Nurse Educator PAY RANGE: $135,200-$170,690 Annually REPORTS TO: Chief Nursing… more
- 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
- 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
- LA Care Health Plan (Los Angeles, CA)
- …in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The expected pay range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
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