- KBR (San Diego, CA)
- …compliance in meeting care goals. * Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... the electronic medical records of all patients contacted for review by the managing physician; Routinely staffs difficult cases... license; full, active, and unrestricted license as a Registered Nurse in one of any US… more
- Centene Corporation (Sacramento, CA)
- …management principles preferred. 25% Travel CA RN License Required **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review … more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …an accredited school of professional nursing. Must maintain current license as a Registered Nurse , Master's degree preferred. + Minimum of 3 years' experience ... knowledge and skills in areas of risk management, infection control, and utilization review . + Current knowledge of continuous quality improvement methodology.… more
- KBR (San Diego, CA)
- …compliance in meeting care goals. * Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... Clearance, or the ability to obtain a clearance. * Current RN license; full, active, and unrestricted license as a Registered Nurse in one of any US State,… more
- LA Care Health Plan (Los Angeles, CA)
- …Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse ( RN );current and unrestricted California ... by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health… more
- University of Southern California (Arcadia, CA)
- …requirements impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review /case management in an ... and other clinical staff. + Meets established productivity targets for record review and appropriate query placement. + Demonstrates working knowledge of ICD-10 CM… more
- Dignity Health (Carmichael, CA)
- …efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality ... **Job Summary and Responsibilities** ** Nurse Manager of Care Coordination / Case Management**...in Nursing or experience equivalent required. + Current CA RN licensure **Sign On / Relocation Options** **Where You'll… 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
- 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
- HCA Healthcare (Thousand Oaks, CA)
- …or spine experience is preferred. + Basic Cardiac Life Support (BLS) - **Required** + ( RN ) Registered Nurse License with the State of California - ... knowledge and expertise! **Job Summary and Qualifications** As a Registered Nurse , you will be responsible for...personal growth, we encourage you to apply for our RN II Ortho Spine opening. We promptly review… more