- Elevance Health (Costa Mesa, CA)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law. The ** Utilization Management Representative I** is responsible for...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible… more
- Cedars-Sinai (Los Angeles, CA)
- …more about you and your skills! **What will you be doing in this role?** The Utilization Review Case Manager validates the patient's placement to be at the most ... Manager follows the UR process as defined in the Utilization Review Plan in accordance with the...- PER DIEM - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
- Providence (Irvine, CA)
- **Description** **RN Utilization Review at Irvine, CA. This position is Full- time and will work Remote 8-hour, Day shifts.** Provide prospective, retrospective, ... strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The… more
- Actalent (Rancho Cordova, CA)
- Utilization Review Nurse About the Role...2-3 years of clinical experience in prior authorization, case management , or utilization management + ... We're looking for a Utilization Review (UR) Nurse to join our...obtain additional clinical information when needed + Support denial management , including appeals and peer‑to‑peer review processes… more
- Providence (Mission Hills, CA)
- …strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The ... reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers,... Utilization Management RN must effectively and efficiently manage a diverse… more
- Cedars-Sinai (Los Angeles, CA)
- …named us one of America's Best Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent ... **Req ID** : 14355 **Working Title** : Registered Nurse - Utilization Review Case Manager - 8 Hour... Case Manager - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
- TEKsystems (Los Angeles, CA)
- …Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims ... Job Title: Retro Claims Reviewer Location: West Hills/Canoga Park 91305 Compensation: LVN...RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity ... Requirement :** **Minimum Experience Requirement :** Minimum of three years of utilization management experience. Experience in quality- related job preferred.… more
- Sharp HealthCare (San Diego, CA)
- …roundsReviews every patient under assigned workload initially and reviews based on review of care plan.Makes rounds and sees every patient identified per ... departmental guidelines during hospital stay beginning with the admission review of the case manager and reviews with the Case Manager Lead, as needed.Keeps SRS… more
- Prime Healthcare (Sherman Oaks, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/239073/case-manager- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... Team of Dedicated Healthcare Workers Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from the… more