- Actalent (Rancho Cordova, CA)
- Job Title: Utilization Review Nurse Job Description The Registered Nurse will review cases for medical necessity across all levels of care, ensuring that ... review. + Collaborate with healthcare teams to facilitate effective utilization management . + Employ MCG criteria and...of strong clinical nursing experience, preferably as a floor nurse or in direct patient care. + Experience in… more
- Sharp HealthCare (San Diego, CA)
- …3 Years case management , utilization review, care coordination experience. + California Registered Nurse ( RN ) - CA Board of Registered Nursing ... Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA...and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge… more
- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** As a Utilization Management RN , you will be crucial in ensuring accurate and compliant medical necessity decisions. Your ... review. You'll work closely with both Pre-Service and In-Patient Utilization Management teams to ensure appropriate and... RN Program. - Clear and current CA Registered Nurse ( RN ) license. -… more
- ERP International (Twentynine Palms, CA)
- **Overview** ERP International is seeking ** Registered Nurse ( RN ) Case Managers** for full-time positions in support of the **Naval Hospital Twentynine ... algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with… more
- University of Southern California (Arcadia, CA)
- …timely and accurate information to payers. The role integrates and coordinates utilization management , care facilitation, and discharge planning functions. The ... to resolve problems with payers as needed. + Completes utilization management for assigned patients. + Coordinates/facilitates.... Licenses and Certifications Minimum (Required) * A current RN licensure in the State of California is required.… more
- The County of Los Angeles (Los Angeles, CA)
- …clinical nursing. LICENSE(S) AND CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board or Registered ... in a state other than California must provide their Registered Nurse License Number from that state...vacancy in Department of Health Services, Harbor-UCLA Medical Center, Utilization Management Division. May also be used… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... and CMS criteria required + A minimum of three years of experience in utilization management , preferred + Team leading or management experience, preferred… more
- LA Care Health Plan (Los Angeles, CA)
- …of Microsoft Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Payment Integrity Nurse Coder RN III Job Category:...process through medical record review for Payment Integrity and Utilization Management projects. The position serves as… more
- Trinity Health (Fresno, CA)
- …the acute care continuum for CVHP members. This includes discharge planning, utilization management , care coordination, and support for resource utilization ... interdisciplinary team to improve patient care through the effective utilization of the facility's resources. The incumbent makes significant...nursing program is preferred. 2. Current licensure as a Registered Nurse in the state of California… more