- ERP International (San Diego, CA)
- **Overview** ERP International is seeking a full-time ** Registered Nurse ( RN ) Health Educator** supporting **Naval Medical Center San Diego, CA ... that of other individuals performing similar services. Participate in peer review and performance improvement activities. Practice aseptic techniques as necessary.… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236088/ rn -case-manager utilization - ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April… more
- Providence (Anaheim, CA)
- …Qualifications:** + Nursing school graduate. + Upon hire: California Registered Nurse License + 3 years Experience in utilization management and/or case ... **Description** Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective… more
- LA Care Health Plan (Los Angeles, CA)
- …requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Utilization Management Admissions Liaison RN II...Management Medical Director, on requests where determination requires extended review . Collaborates with the inpatient care team for facilitation/coordination… more
- Centene Corporation (San Diego, CA)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... abuse addiction disorders experience is required. + Direct experience with Utilization Review or Utilization Management related to Behavioral Health case… more
- Centene Corporation (Sacramento, CA)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... are seeking a Licensed Clinical Behavioral Health Professional or RN to join our team! The ideal candidate will...abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with… more
- CenterWell (Sacramento, CA)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent… more
- 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
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... outcomes and reducing readmissions. #LI-CC2 Qualifications Required qualifications: 1. CA Registered Nurse 2. Bachelor's of Science in Nursing3. Grandfathered… 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:...policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management… more