- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... team members; arranges follow up care as appropriate. + Utilization Review - Review prospectively,...patient health care **Licenses and Certifications** + CA-RN (Registered Nurse ) required **These principles apply to ALL employees:** **SHC… 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 ... reviewing medical records, authorizing services, and preparing cases for physician review . You'll work closely with both Pre-Service and In-Patient Utilization… more
- University of Southern California (Arcadia, CA)
- …outside referring physicians andmedical groups.* Communicates with insurance company utilization review and authorization personnel.* Gathers and maintains ... Quality ReviewDepartment/Hospital Administration.* Acts as a resource person for nurse coordinators, nursing, and other hospital staff.* Reviews, interprets,… more
- Ventura County (Ventura, CA)
- …that establish, expand, and maintain the pool of eligible service providers. + Utilization review : + Uses professional skills in quality management activities ... Description Are you a licensed Psychiatric Technician or Vocational Nurse in California looking to make a real difference...such as utilization review , monitoring and evaluation procedures, and… more
- Stanford Health Care (Palo Alto, CA)
- …development of their APPs. The Lead APP also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse ... and adherence to policy through practice analysis and case review of APPs with physicians. . Investigate and respond...development of their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS),… 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...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more
- Sharp HealthCare (San Diego, CA)
- …(CPPS) - Certification Board for Professionals in Patient Safety; California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree **Hours** ... improve clinical outcomes including responsibilities relating to leading teams in the utilization of Change Acceleration Process and PI tools and providing feedback… more
- Elevance Health (Walnut Creek, CA)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... and supportive care. + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Stanford Health Care (Palo Alto, CA)
- …clinical competency and adherence to policy through practice analysis and case review of APPs with physicians. + Investigates and responds to patient/family ... practice based on evidence by using research based knowledge or research utilization methods to identify and implement innovations in patient care and/or… more
- Providence (Santa Rosa, CA)
- …with management, medical staff and medical center personnel. Provides payor/ utilization review organizations with concurrent retrospective utilization ... center personnel and outside resources to ensure the appropriate utilization of resources according to clinical and financial standards....due within 90 days of hire. + Coursework/Training: General Nurse Competency due within 30 days of hire. +… more