• Utilization Review Specialist

    TEKsystems (Canoga Park, CA)
    Position: Utilization Review Nurse Work Enviroment: Hybrid work schedule Schedule: Full time position, Flexible start time of 7-8 am, 5 days x 8hrs , no ... or LVN with an active license to help address claims retro review . This role focuses on.... This role focuses on reviewing inpatient and outpatient claims for medical necessity and compliance, ensuring… more
    TEKsystems (11/20/25)
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  • Inpatient DRG Reviewer

    Zelis (FL)
    …Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest ... plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records...standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding… more
    Zelis (09/27/25)
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  • Mental Health Program Manager II / Emergency…

    The County of Los Angeles (Los Angeles, CA)
    …practice as a clinical social worker, marriage and family therapist, psychologist, or registered nurse issued by the appropriate State of California licensing ... practice as a clinical social worker, marriage and family therapist, psychologist, or registered nurse issued by the appropriate State of California licensing… more
    The County of Los Angeles (10/09/25)
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  • Senior Nursing Instructor (Informatics)

    The County of Los Angeles (Los Angeles, CA)
    …change management goals. Requirements SELECTION REQUIREMENTS: + A License to practice as a Registered Nurse issued by the California Board of Registered ... hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty...INFORMATION; A current active license to practice as a Registered Nurse issued by the California Board… more
    The County of Los Angeles (10/16/25)
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  • Manager Patient Safety

    Dignity Health (Long Beach, CA)
    …not to exceed 10% of salary for this position.** Our ideal candidate will be a Registered Nurse ( RN ) with experience in patient safety and risk management ... Manager of Patient Safety and Risk at St. Mary Medical Center, you will oversee the facility's Patient Safety...of the organization. Preferred Qualifications: + Licensure as a Registered Nurse ( RN ). \#LI-DH **Where… more
    Dignity Health (10/18/25)
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  • Medicaid Special Programs Case Manager

    CDPHP (Latham, NY)
    …invites you to be a part of that experience. The Medicaid Special Programs Registered Nurse Case Manager is responsible and accountable for coordinating the care ... and cost outcomes. In addition, the Medicaid Special Programs Registered Nurse Case Manager is responsible and...medical services across the health care continuum. The RN Case Manager will demonstrate strengths in working independently… more
    CDPHP (11/21/25)
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  • Residence Counselor/ Medical Coordinator

    Constructive Partnerships Unlimited (Brooklyn, NY)
    …the Residence Manager, and reports all medical issues/ injuries to the registered nurse and follows protocols for notification. 13. Performs variety of ... reports and maintaining database of consumer health information after review and signed by the RN . +...+ Performs all other duties as assigned by the registered nurse . II. POSITION REQUIREMENTS A. Qualifications… more
    Constructive Partnerships Unlimited (11/12/25)
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  • Long Term Care Benefits Planner I/II (Rochester…

    Excellus BlueCross BlueShield (Rochester, NY)
    …time-service standards required by the Company. + Evaluates Insured's condition through review of field assessments, medical records, etc. Determines benefit ... with Insured, Insured's family, care providers, and monitoring of claim submission and processing. All work is directed under...care customer service. + Must have the ability to review and interpret medical records and assessments… more
    Excellus BlueCross BlueShield (11/08/25)
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  • ADA Accommodation Specialist

    Sedgwick (San Antonio, TX)
    …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... and/or client requirements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reviews medical information for ADAAA temporary and permanent accommodation requests. +… more
    Sedgwick (11/21/25)
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  • Senior Nursing Instructor

    The County of Los Angeles (Los Angeles, CA)
    …as a nursing instructor* or its equivalent. + A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing. + ... hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty...applicants must have a license to practice as a Registered Nurse issued by the California Board… more
    The County of Los Angeles (10/18/25)
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