- Sharp HealthCare (San Diego, CA)
- …their financial impact of the service line.Complies with payer guidelines on utilization review process to promote optimal reimbursement. **Knowledge, Skills, ... + Understanding of performance improvement and research methodologies. + Knowledge of utilization review criteria and health care finances. + Excellent telephone… more
- Ventura County (Ventura, CA)
- …expand, and maintain the pool of eligible service providers. + Utilization review : + Uses professional skills in quality management activities such as ... Description Are you a licensed Psychiatric Technician or Vocational Nurse in California looking to make a real difference...other members of the mental health team. + Case Management : + provides case management /brokerage including linkage… more
- Cedars-Sinai (CA)
- …the established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review for ... America's Best Hospitals! **What You Will Do in This Role:** A Registered Nurse Case Manager plans and coordinates care of the patient from pre-hospitalization… more
- Stanford Health Care (Palo Alto, CA)
- …least 3 years in a surgical specialty as a Physician Assistant (PA) or Nurse Practitioner (NP), with a preference for at least 1 year in Plastic/Reconstructive ... is a Stanford Health Care job.** **A Brief Overview** Provides supervision and management of advanced practice providers (APPs) in a distinct clinical service line.… more
- CenterWell (San Diego, CA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Rising Medical Solutions (Los Angeles, CA)
- …medical case management , occupational health, orthopedics, home health care, utilization review , or quality assurance + Familiarity with regional physicians ... Your Career with Rising Medical Solutions Are you an experienced workers' compensation nurse case manager eager to bring your expertise to a team that's passionate… more
- Sharp HealthCare (La Mesa, CA)
- …Healthcare Quality (CPHQ) - National Association for Healthcare Quality; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Professional in ... for Professionals in Patient Safety; Certified Professional in Healthcare Risk Management (CPHRM) - American Hospital Association; Master's Degree; Bachelor's Degree… more
- Cedars-Sinai (Beverly Hills, CA)
- …for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to ... reporting to the TPL carrier of all injured worker cases receiving case management services. + Ensures appropriate utilization of medical services within the… 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 ... **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing &...related to front desk responsibilities including scheduling and telephone management . Acts as a positive role model and ensures… more
- Trinity Health (Fresno, CA)
- **Employment Type:** Part time **Shift:** **Description:** This position coordinates utilization review service for defined patient populations across the acute ... care continuum. This includes discharge planning, utilization management , care coordination collaboration, and support...the facility's resources. 1. Current licensure as a Registered Nurse (RN) in the state of California is required.… more
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