- Emanate Health (Covina, CA)
- …Education Requirement:** **Minimum Experience Requirement:** Minimum of three years of utilization management experience. Experience in quality - related job ... States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by… more
- Sharp HealthCare (San Diego, CA)
- …Testing and/or failed to pass testing on second attempt= Needs Improvement. + Quality InitiativesCompletes quality assurance assignments as directed and ... Life Support (PALS) - American Heart Association; California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians; AHA Basic… more
- Sharp HealthCare (San Diego, CA)
- …and/or failed to pass testing on second attempt = Needs Improvement + Quality initiativesCompletes Quality Assurance (QA) assignments and ensures overall ... (AHA BLS Healthcare) - American Heart Association; California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians; ACLS… more
- Dignity Health (Rancho Cordova, CA)
- …Excel, Access, PowerPoint) **Preferred:** + Clinical experience with quality assurance /improvement is desirable, preferably as an RN, LVN , Pharmacist, ... to collaborate with members of NSSA Regional Health Services Research (HSR), Utilization Management, Quality Management and various other departments, in the… more
- CVS Health (Phoenix, AZ)
- …is complying with regulatory requirements and accreditation standards. * Participates in quality assurance activities on ongoing basis, including but not limited ... other prior authorization assignments as delegated by the leadership team. * Utilization of clinical and problem-solving skills to support the research of… more
- Centene Corporation (Atlanta, GA)
- …for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. + Prepares case reviews for Medical ... for experienced nurses with a strong background in **appeals, denials, utilization management, clinical review, and claims** . **Preferred Requirements:** + Active… more
- Hospice Of San Joaquin (Stockton, CA)
- …of assigned staff, as well as ensuring the compliance of patient visit schedules, quality assurance activities, and coordination of care in the absence of the ... assist with care coordination as requested, back up the LVN Supervisor in the receipt of patient phone calls...Ensures compliance with the Hospice program plan by assuring quality service, appropriate utilization of resources, and… more
- Centene Corporation (New York, NY)
- …for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. + Prepares case reviews for Medical ... of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. RN or LPN Preferred NY...Licensed Practical Nurse - State Licensure required or + LVN - Licensed Vocational Nurse required or + RN… more