- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patiens receive… more
- Elevance Health (Walnut Creek, CA)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Location:** Virtual: This role...responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing… more
- Centene Corporation (Sacramento, CA)
- …offering competitive benefits including a fresh perspective on workplace flexibility. **Concurrent Review Nurse - Remote (California Market | Health Net)** ... Centene is seeking a **Remote Concurrent Review Nurse ** to support our **Health Net...2 years in acute care and managed care, with utilization management experience This is a great opportunity to… more
- Prime Healthcare (Chino, CA)
- …for its quality, including as among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum… more
- Prime Healthcare (San Dimas, CA)
- …effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service ... post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 years post… more
- Centene Corporation (Sacramento, CA)
- …California RN Licensing Highly Preferred **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine if the level of ... quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against guidelines and clinical… more
- LA Care Health Plan (Los Angeles, CA)
- …and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The ... Payment Integrity Nurse Coder RN III Job Category: Clinical Department:...inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to… more
- Alameda Health System (Oakland, CA)
- …necessarily performed by each individual in the classification. + Coordinates all utilization review functions, including response to payor requests for ... Nurse , Care Management + Oakland, CA + Highland...experience in Case Management in an acute setting or utilization review at a medical group or… more