- Stanford Health Care (Palo Alto, CA)
- …Brief Overview** The Oncology Research Nursing Professional (ORNP) -is a Registered Nurse (RN) who works collaboratively with Clinical Research Staff including, but ... triage of phone calls and proactive patient communication. The Oncology Research Nurse Professional -serves to educate patients and families on the clinical trial… more
- Highmark Health (Sacramento, CA)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Sharp HealthCare (Chula Vista, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... Sterile Product Certification) - Various-Employee provides certificate; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing &...Follows policy and procedure for entering of OCM and utilization of IDX. Completes work within assigned hours.Able to… more
- The County of Los Angeles (Los Angeles, CA)
- …goals. + Develops and implements reporting procedures to ensure that program services utilization and revenue data are reported accurately and in a timely manner. + ... of care and establishes and modifies program monitoring and review methods as necessary. + Oversees audits and the...A valid, current license to practice as a registered nurse issued by the appropriate State of California licensing… more
- Providence (CA)
- …in a medical record. + 2 years - HEDIS, Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and pharmacy records… more
- Actalent (Sacramento, CA)
- …(eg, med-surg, telemetry, ICU) + At least 1 year of experience in utilization review , case management, or hospital discharge planning + Familiarity with ... Remote Licensed Vocational Nurse (LVN) Fully remote but MUST reside within...of the Sacramento area Job Duties + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and… more
- The County of Los Angeles (Los Angeles, CA)
- …goals. Develops and implements reporting procedures to ensure that program services utilization and revenue data are reported accurately and in a timely manner. ... acceptable standards of care and establishes and modifies program monitoring and review methods as necessary. Oversees audits and the implementation of audit… more
- STG International (Victorville, CA)
- …patient safety. *Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health ... in the orientation of clinical staff physicians, physician assistants and nurse practitioners. *Provide leadership to CBOC clinicians. *Evaluate the effectiveness of… more
- Alameda Health System (San Leandro, CA)
- …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... the direction of the Care Management social worker and/or nurse , facilitates, identifies and documents all referrals made to...in a health care field or one year in Utilization Management at a Medical Group or Health plan… more