- Ami Network (Pasadena, CA)
- …60k+ members from major Health Plans like Anthem, SCAN, and Alignment Health. As the Utilization Review Director, you'll oversee 4 direct reports on the IPA side ... with a large healthplan organization to find their next Utilization Management Director in Pasadena. Our client is a...Healthplan Experience + Medicare Advantage 3-5 years Management Experience RN in CA Daily audits of UM until they… more
- Arthur J. Gallagher & Co. (AJG) (Torrance, CA)
- …the PRIME program in the marketplace; manage bill review and the nurse case managers including utilization review and case management functions. ... the state. How you'll make an impact Manage Bill Review and Managed Care units. Review and...knowledge of industry best practices and procedures. Active California RN license required. Preferred: 15 plus years claims experience… more
- Kaiser Permanente (Vallejo, CA)
- …the standards for corrective action plan for improvement identified through utilization review , clinical records audit, claim denials, member satisfaction ... hire OR Professional Healthcare Quality Certificate within 24 months of hire Registered Nurse License (California) Notes: Knowledge, Skills, and Abilities… more
- Kaiser Permanente (Pleasanton, CA)
- …by: researching corrective action plan for areas of improvement identified through utilization review , clinical records audit, claim denials, member satisfaction ... experience in quality, performance improvement, or a directly related field. Registered Nurse License (California) Additional Requirements Knowledge, Skills, and… more
- University of California San Diego (San Diego, CA)
- …the financial outcomes for the medical center. MINIMUM QUALIFICATIONS Bachelor's degree in nursing. Registered Nurse ( RN ) issued by the state of California. ... is an experienced senior leader and subject matter expert in utilization review , discharge planning and acute care case management/care management department… more
- DCI Donor Services (West Sacramento, CA)
- …5+ years' OPO clinical management experience required. Bachelor's degree in Health Administration Registered Nurse ( RN ) license Valid Driver's License with ... - including donor authorization, donor management, organ recovery, logistics, and organ utilization . This role is critical to providing leadership and guidance to… more
- The County of Los Angeles (Los Angeles, CA)
- …Considerable ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience ... OPTION II: Two (2) years of experience as a registered nurse , of which one year must...the County of Los Angeles, a Utilization Review Nurse is an RN ...Los Angeles, a Utilization Review Nurse is an RN that has Case… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR...CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board ... II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 -… more
- Cedars-Sinai (Los Angeles, CA)
- …reviews with accepted criteria required **Req ID** : 14141 **Working Title** : Registered Nurse - Utilization Review Case Manager - PER DIEM - 8 Hour ... more about you and your skills! **What will you be doing in this role?** The Utilization Review Case Manager validates the patient's placement to be at the most… more
- Centene Corporation (Sacramento, CA)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... are seeking a Licensed Clinical Behavioral Health Professional or RN to join our team! The ideal candidate will...abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with… more
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