- 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
- Alameda Health System (Alameda, CA)
- …and a resolution is initiated and presented weekly at Medicare or Utilization Review meetings. **MININUM QUALIFICATIONS** : Education: Graduate of accredited ... OBRA assessments. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Required Licenses/Certifications:… 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
- 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
- Insight Global (Los Angeles, CA)
- …2+ years in a lead or supervisor role EMR system experience valid California Registered Nurse ( RN ) license Current Basic Cardiac Life Support (BLS/CPR) ... Job Description Insight Global is seeking a skilled Registered Nurse Supervisor for a community...duties under the supervision of the Nursing Director. The RN Supervisor will manage on average 5 employees between… 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)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals &...clinical unit. This position is responsible for the quality review of complex and/or escalated clinical A&G cases for… more
- CommonSpirit Health (Rancho Cordova, CA)
- **Job Summary and Responsibilities** **I** **CU** ** RN , Emergency Room RN or Level One Trauma RN experience strongly preferred.** **Job Summary:** The ... to carry out the patient logistics program responsibilities. The Patient Logistics RN Clinical Coordinator collaborates with customers and staff to ensure efficient… more