- Elevance Health (Los Angeles, CA)
- …weekends.** **(Saturday 8am-12pm CST, with a comp day during the week)** The ** Nurse Reviewer I** will be responsible for conducting preauthorization, out of network ... ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or… more
- Highmark Health (Sacramento, CA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans to… more
- Elevance Health (Costa Mesa, CA)
- The ** Nurse Reviewer** is responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by ... ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or… more
- University of Southern California (Arcadia, CA)
- …nursing unit is responsible for the day-to-day operations, direct supervision of the RN staff, and assists the Director and/or Manager with the operational ... of the patients during hospitalization to obtain the best utilization of resources so that patient outcomes are optimized....preferred. Licenses and Certifications Minimum (Required) * A current RN license in the State of California is required.… more
- CenterWell (Sacramento, CA)
- …**Use your skills to make an impact** **Required Qualifications** + Must be a licensed Registered Compact Nurse license ( RN ) with no disciplinary action and ... caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge,...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more
- UCLA Health (Los Angeles, CA)
- …As our Nurse Supervisor you will partner with the Cardiovascular Manager to oversee daily clinic operations, provide leadership to clinical staff and ensure ... You will independently manage workflow, staffing, regulatory compliance and resource utilization while fostering a culture of teamwork, continuous improvement, and… more
- UCLA Health (Los Angeles, CA)
- …and skilled nursing facility utilization who are not assigned to a case manager . Under the direction of the RN Assistant Director, this role provides ... non-clinical care coordination, referral and authorization processing, and service navigation for high- to moderate-acuity patients. The position focuses on ED diversion, safe discharge planning, timely access to services, and prevention of avoidable hospital… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …crucial role in optimizing cost-efficiency and quality in the procurement and utilization of medical supplies and equipment. This position requires a dedicated ... 4 years prior bedside nursing experience (Does not require a current RN license) Excellent communication and interpersonal skills to collaborate with various… more
- Fresenius Medical Center (Lancaster, CA)
- …dialysis clinic. You will collaborate with the Medical Director and the Charge Nurse regarding the provision of quality patient care in the dialysis clinic. ... Quality, and Technical Services departments. + Collaborates with the Home Therapies Manager to oversee the facility's Home Therapies Program. + Maintains integrity… more
- University of Southern California (Arcadia, CA)
- …impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in an acute care ... physicians, associates, and adheres to HIPAA regulations. Keep the CDI team and HIM Manager or Director informed of workflow status and potential backlog issues. more