- 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
- The County of Los Angeles (Los Angeles, CA)
- …work at the direction of a rehabilitation therapist, social worker, or registered nurse . Incumbents are typically responsible for providing technical direction ... clients most prone to assaultive behavior or requiring more extensive monitoring and review of their condition and progress. Essential Job Functions + Interviews the… more
- The County of Los Angeles (Los Angeles, CA)
- …work at the direction of a rehabilitation therapist, social worker, or registered nurse . Incumbents are typically responsible for providing technical direction ... most prone to assaultive behavior or requiring more extensive monitoring and review of their condition and progress. Essential Job Functions + Administers, either… more
- Veterans Affairs, Veterans Health Administration (Eureka, CA)
- …become available. Responsibilities VA Careers - Licensed Practical Nurse : https://youtube.com/embed/Ae85IP1Oiz4 Total Rewards of a Allied Health Professional ... The Intermittent Licensed Vocational Nurse /Practical Nurse (LVN/LPN) has a broad degree...and responsibilities of the LVN/LPN include: Performs retrospective medical review of non-VA health care records to determine medical… more
- Amergis (Orange, CA)
- …help support a health insurance agency! The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for ... providers. The incumbent will be responsible for prior authorizations, concurrent review and related processes. Position Details: Location: Orange (Full Office, no… more
- Parexel (Sacramento, CA)
- …reproducible research practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable health professional credentials, ... solutions, and ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or anomalies to ensure… more
- Fresenius Medical Center (Anaheim, CA)
- …priority management, and recommendation and implementation changes of current methods. + Review and comply with the Code of Business Conduct and all applicable ... of service being provided to the customers. + In-depth review with direct reports on the data retrieved from...for improvement eg Compliance, Billing, and Quality Indicators. + Utilization of data to better understand their business unit(s)… more