- 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
- Evolent (Sacramento, CA)
- …coordinating with UM staff to ensure timely and accurate communication of clinical decisions. + Responsible for completion of UM projects and participation ... the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and… more
- Evolent (Sacramento, CA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member...medical management activities in a managed care environment + UM /UR experience + Clinical experience in Oncology,… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... Experience Required: At least 5 years of varied RN clinical experience in an acute hospital setting. At least...and Medicaid Services(CMS) requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse … more
- Cedars-Sinai (Los Angeles, CA)
- …of America's Best Hospitals. Summary of Essential Duties: + The Utilization Management ( UM ) Registered Nurse - Medicare Short Stay & Concurrent Denials supports ... **Job Description** Are you ready to bring your expert clinical skills to a world-class facility recognized as one...in accordance with CMS requirements and payer timelines. The UM RN collaborates with physicians, revenue integrity, and payer… more
- ERP International (Twentynine Palms, CA)
- **Overview** ERP International is seeking **Registered Nurse (RN) Case Managers** for full-time positions in support of the **Naval Hospital Twentynine Palms, CA** ... such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, CM software, and databases for community resources.… more
- Cedars-Sinai (CA)
- …care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to ... day (preferably on day of admission). + Submits necessary clinical information to the health plan using the accepted...are transitioning to the Skilled Nursing Facilities, refers to nurse practitioner and case manager assigned to the SNF's… 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 ... panel of members that range in health status/severity and clinical needs; and assesses health management needs of the...RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or… 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 ... us one of America's Best Hospitals. As a Registered Nurse , Care Coordinator at Cedars-Sinai you will; + You...Cedars-Sinai you will; + You will serve as a clinical co-pilot-charting the best trajectory of each patient's care… more