- Sharp HealthCare (San Diego, CA)
- …**Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... + 2 Years Medical Management experience, preferably in a managed care setting + California Registered Nurse ( RN ) - CA Board of Registered Nursing… more
- Stanford Health Care (Palo Alto, CA)
- …their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or ... and adherence to policy through practice analysis and case review of APPs with physicians. + Investigate and respond...practice provider: (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered Nurse… more
- The County of Los Angeles (Los Angeles, CA)
- …mental health team. Option III : A valid, current license to practice as a registered nurse issued by the appropriate State of California licensing agency -AND- ... and implements reporting procedures to ensure that program services utilization and revenue data are reported accurately and in...have a valid, current license to practice as a registered nurse issued by the appropriate State… more
- Evolent (Sacramento, CA)
- …**Qualifications Required and Preferred:** + Current, unrestricted state licensure as a Registered Nurse - **Required** + Associate or Bachelors in Nursing (Must ... , you will be a key member of the utilization management team. We can offer you a meaningful way...be a Registered Nurse ) - **Required** + You must be… more
- HCA Healthcare (Thousand Oaks, CA)
- …Care role today!** **Job Summary and Qualifications** The Clinical Nursing Manager is a registered nurse who reports directly to the unit Director or Chief ... for monitoring the delivery of patient care through the utilization of the nursing process, physicians' orders, established policies...of nursing; BSN desired, MSN preferred. + Current California Registered Nurse License. + Current BCLS and… more
- Evolent (Sacramento, CA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Highmark Health (Sacramento, CA)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Sutter Health (San Mateo, CA)
- …+ Other: Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California + BLS-Basic Life Support Healthcare ... and assists in meeting financial targets by effectively managing utilization , productivity, personnel and supplies. Participates as necessary in referral… more
- Sutter Health (San Francisco, CA)
- …+ Master's in Healthcare (MPH, MHA, MS, MBA, etc.) **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California OR MD-Medical Doctor OR DO-Doctor of ... transition, including potential impact on data quality for prospective payments, utilization , and reimbursement. Knowledge of ICD-10 desirable. + Strong Organization… more
- City and County of San Francisco (San Francisco, CA)
- …an accredited college or university AND LICENSE: Current, valid, unrestricted license as a Registered Nurse in the State of California AND EXPERIENCE: Four (4) ... staff, department heads, and NHA in matters related to nursing service 5. Review daily work assignments to ensure they meet regulatory compliance and provide… more