- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW ... comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're… more
- Actalent (Rancho Cordova, CA)
- Utilization Review Nurse About the Role We're looking for a Utilization Review (UR) Nurse to join our team and support high‑quality, ... to ensure appropriate levels of care. Key Responsibilities + Conduct utilization reviews for inpatient, outpatient, and ancillary services using established clinical… more
- Prime Healthcare (Ontario, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236094/ utilization - review - nurse ... Plan. Qualifications Required qualifications: + Possess an active CA Licensed Vocational Nurse (LVN) license. + Minimum (2) two years of experience in acute… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices....support and review of medical claims and utilization practices. Complete medical necessity and level of care… more
- Actalent (Rancho Cordova, CA)
- Job Title: Utilization Review Nurse Job Description The Registered Nurse will review cases for medical necessity across all levels of care, ensuring ... that patients receive appropriate and necessary treatment. Responsibilities + Review medical cases for necessity at all levels of care. + Utilize strong clinical and… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established… more
- CVS Health (Sacramento, CA)
- …cardiology **Preferred Qualifications** -1+ years' experience in either Precertification or Utilization Review -1+ years' experience Managed Care -Strong ... it all with heart, each and every day. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is fully remote but must reside in PST… more
- Alameda Health System (San Leandro, CA)
- …Follows AHS (Alameda Health System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of acute inpatient services. ... Clinical Nurse III, Acute Inpatient Behavioral Health Utilization...EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review , membership in… 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: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Cognizant (Sacramento, CA)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,… more