- CenterWell (Sacramento, CA)
- …our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
- UCLA Health (Los Angeles, CA)
- …clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital...contributes to performance improvement projects. + Remains current with clinical best practices and UM regulatory changes.… more
- Dignity Health (Bakersfield, CA)
- …Management ( UM ) Policies and procedures promptly, efficiently and accurately. The UM Coordinator collaborates with clinical team members to evaluate the ... potential over and under-utilization of specialty services based on clinical protocols. Essesntial functions include: - Communicate effectively and interact with the… more
- Veterans Affairs, Veterans Health Administration (Redlands, CA)
- …Model .The Community Care RN Clinical Coordinator is supervised by the VACC Clinical Nurse Manager whose immediate supervisor is the Chief of Community Care. ... Summary The Community Care RN Clinical Coordinator is a registered professional nurse... Clinical Coordinator utilizes comprehensive knowledge of advanced clinical practice and UM principles to assess… more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Telephonic Nurse Case Manager will be a member of the In-Home Case Management Team, providing a ... beneficiary's capacity for self- care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care....and to enhance quality of medical care. The **Telephonic Nurse Case Manager** will collect and document data to… more
- Cedars-Sinai (CA)
- **Job Description** Are you ready to bring your expert clinical skills to a world-class facility recognized as one of the top ten in the United States? Do you have a ... pioneering capabilities. Summary of Essential Duties: Serve as a clinical co-pilot-charting the best trajectory of each patient's care...Surgical/Tele/ICU) with 2 or more year ofcare management experience ( UM or DC Planning). + At least 3 years… more
- Cedars-Sinai (CA)
- **Job Description** Are you ready to bring your expert clinical skills to a world-class facility recognized as one of the top ten in the United States? Do you have a ... America's Best Hospitals. + You will serve as a clinical co-pilot-charting the best trajectory of each patient's care...with 2 or more year of care management experience ( UM or DC Planning). + Knowledge of medical literature,… more
- Highmark Health (Sacramento, CA)
- …experience, or provider operations and/or health insurance experience + 1 year in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year ... over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and… more
- UCLA Health (Los Angeles, CA)
- Description We are seeking a highly skilled and dynamic Director of Clinical Services to lead the development, evaluation, and implementation of multiple clinical ... care. You will: + Oversee the development and execution of multiple UM processes and workflows, while continuously identifying and evaluating areas for improvement… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations of the UM… more
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