TravelNurseSourceNewTravel Nurse RN - Utilization Review - $1,948 to $2,043 per week in Mission Viejo, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $1,948 to $2,043 per week in Mission Viejo, CAMission Viejo, CA$1,948–$2,043As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
TravelNurseSourceNewTravel Nurse RN - Utilization Review - $2,065 to $2,160 per week in Mission Viejo, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $2,065 to $2,160 per week in Mission Viejo, CAMission Viejo, CA$2,065–$2,160As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
Health Source MSOCase Manager RN Health Source MSOCase Manager RNAlhambra, CAFull timeMonitors nursing and medical plans of care/discharge plans and provides appropriate interventions to assure care is appropriate, coordinated and that avoidable patient days are addressed effectively through education, consultation, and counseling as needed. Ensures collaboration between multidisciplinary healthcare team members, primary physician, community agencies, HMOs/PPOs, CCS, etc., whose services may be required and/or related to the care needs of the patient after hospital discharge.
SHARP HEALTHCARESRS - Lead – RN - Pediatrics - Full Time - Day Shift SHARP HEALTHCARESRS - Lead – RN - Pediatrics - Full Time - Day ShiftRiverside, CA$80,000–$96,000 / yearThe actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. Demonstrates typing skills proficiency by: Using a keyboard, required to type proficiently and accurately; Have the ability to type a minimum of 30 words per minute with 0-2 errors; Have the ability to proof work.
San Gabriel/Pomona Regional CenterNewNurse - Clinical Services San Gabriel/Pomona Regional CenterNurse - Clinical ServicesPomona, CA$76,544–$131,372.76 / yearSan Gabriel/Pomona Regional Center (SG/PRC) is a private, nonprofit agency contracted with the California Department of Developmental Services (DDS) to provide services and supports to individuals with intellectual and developmental disabilities. Core responsibilities include assessments, evaluations, consultations, and delivery of high-quality care, ensuring individuals served receive appropriate medical care and that staff and families are well-informed and supported in managing health needs.
Health Source MSOCase Management Coordinator Health Source MSOCase Management CoordinatorAlhambra, CAFull timeJob Description: In the UM department, Case Management Coordinator is to assist with the coordinating of the day-to day activities in the medical group, request for authorization for ancillary services, and certify the group is utilizing the most cost effective provider. Also, identify patients found in out-of-network facilities and send the information timely to the concurrent-review nurse for coordination with the hospital and group.
PIH HealthNewRN PIH HealthRNWhittier, CA$55–$87.50 / hourThe fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology.
Adventist HealthNewRN - Lead Care Manager (Full-Time, Day Shift) Adventist HealthRN - Lead Care Manager (Full-Time, Day Shift)Bell Gardens, CAJob Requirements: Education and Work Experience: Bachelor's Degree in Nursing (BSN): Preferred Experience in a care management role: Preferred Licenses/Certifications: Registered Nurse (RN) licensure in the state of practice: Required Case management certification: Preferred Essential Functions: Leads the coordination of patient care with other disciplines within the care team, monitoring the appropriateness and timeliness of care. Ensures the interdisciplinary care plan is consistent with the patient's clinical course, continuing care needs and covered services by monitoring diagnostic testing, treatments and procedures, and other aspects of patient care as appropriate for acute care.
eTeam Inc.Utilization Review RN eTeam Inc.Utilization Review RNOrange, CACandidate must be highly proficient in EPIC and InterQual, with demonstrated experience using both systems for clinical review and medical necessity determination. Shift: Day 5x8-Hour (09:00 - 17:30) .
AkidoNewClinical Review Nurse - Prior Authorization AkidoClinical Review Nurse - Prior AuthorizationChino, CA$62,400–$93,600 / yearServing 500K+ patients across California, Rhode Island, and New York, Akido offers primary and specialty care in 26 specialties—from serving unhoused communities in Los Angeles to ride-share drivers in New York. Akido is the first AI-native care provider, combining cutting-edge technology with a nationwide medical network to address America's physician shortage and make exceptional healthcare universal.
eTeam Inc.Utlization Review RN eTeam Inc.Utlization Review RNOrange, CA$60–$65 / hourCandidate must be highly proficient in EPIC and InterQual, with demonstrated experience using both systems for clinical review and medical necessity determination. Pre-approved time off per contract no to exceed 5 days.
APN Consulting IncRegistered Nurse/Utilization Review APN Consulting IncRegistered Nurse/Utilization ReviewWhittier, CAThe EPR-RN performs, and supervises the EPRN-LVN, in utilization review with a prominent level of expertise by using approved criteria that demonstrates medical necessity to achieve appropriate authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, or Outpatient). The Emergency Prospective Review (EPR) Nurse RN has the responsibility to conduct a review of all patients requiring hospital admission from the emergency room at all PIH and non-PIH facilities (for PHP members) after stabilizing care has been initiated for medical necessity and appropriateness.
Centene Corporation GroupNewClinical Review Nurse - Concurrent Review (RN) Centene Corporation GroupClinical Review Nurse - Concurrent Review (RN)Remote-CA, CARemote$27.02–$48.55 / hourPosition Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines.
CorVel Healthcare CorporationCA Utilization Review Nurse I CorVel Healthcare CorporationCA Utilization Review Nurse IRancho Cucamonga, CARemote$30.64–$45.80 / hourPart timeThe Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay while supporting the goals of the Case Management department and of CorVel. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.
Inland Empire Health PlanProvider Quality Review Nurse, RN Inland Empire Health PlanProvider Quality Review Nurse, RNRancho Cucamonga, California$91,249.60–$120,910.40 / yearMaintain direct communication with IEHP departments, external facilities including hospitals, Skilled Nursing Facilities, and/or Providers to ensure all PQI issues are thoroughly investigated, and care is coordinated in a timely manner, as needed. Issue Corrective Action Plans (CAP), review CAP responses, draft Opportunity for Improvement letters, and coordinate other interventions as needed to ensure all issues were addressed and future occurrences of the same issue are mitigated.
NavitasPartnersNewRN - Utilization Review - Apple Valley, CA - RN26-06574 NavitasPartnersRN - Utilization Review - Apple Valley, CA - RN26-06574Rancho Cucamonga, CAAbout Navitas Healthcare, LLC: It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. Collaborate with physicians, case managers, social workers, and interdisciplinary teams to support appropriate patient care and resource utilization.
NavitasPartnersNewRegistered Nurse – Utilization Review - RNUR 26-06574 NavitasPartnersRegistered Nurse – Utilization Review - RNUR 26-06574Fontana, CAAbout Navitas Healthcare, LLC: It is a certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. Minimum of four (4) weekend day shifts required within each six-week scheduling period; additional weekend coverage may be required based on operational needs.
St. Francis Medical CenterRN Case Manager - Utilization Review St. Francis Medical CenterRN Case Manager - Utilization ReviewLynwood, California$47.20–$63.45 / hourThe methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the hospital for high quality and compassionate medical care.
Providence Health & ServicesRN Utilization Review - Per Diem - REMOTE Providence Health & ServicesRN Utilization Review - Per Diem - REMOTEIrvine, CARemote$57.28–$88.92 / hourRequsition ID: 434193 Company: Providence Jobs Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Part time Job Shift: Multiple shifts available Career Track: Nursing Department: 7000 UTILIZATION MGMT OCHD Address: CA Irvine 15480 Laguna Canyon Rd Work Location: Providence System Offices Discovery Park-Irvine Workplace Type: On-site Pay Range: $57.28 - $88.92 Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.
Providence Health & ServicesNewRN Utilization Review - Full-time - REMOTE Providence Health & ServicesRN Utilization Review - Full-time - REMOTEIrvine, CARemote$57.28–$88.92 / hourRequsition ID: 437582 Company: Providence Jobs Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 7000 UTILIZATION MGMT OCHD Address: CA Irvine 15480 Laguna Canyon Rd Work Location: Providence System Offices Discovery Park-Irvine Workplace Type: Remote Pay Range: $57.28 - $88.92 Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.
Providence St. Joseph HealthRN Utilization Review - Per Diem - REMOTE Providence St. Joseph HealthRN Utilization Review - Per Diem - REMOTEIrvine, CARemoteThe Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Providence St. Joseph HealthNewRN Utilization Review - Full-time - REMOTE Providence St. Joseph HealthRN Utilization Review - Full-time - REMOTEIrvine, CARemoteThe Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Alura Workforce SolutionsHEDIS Clinical Review Nurse, LVN 25-00527 Alura Workforce SolutionsHEDIS Clinical Review Nurse, LVN 25-00527Rancho Cucamonga, CAREQUIREMENTSThree (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
Alura Workforce SolutionsHEDIS Clinical Review Nurse, LVN 25-00492 Alura Workforce SolutionsHEDIS Clinical Review Nurse, LVN 25-00492Rancho Cucamonga, CAREQUIREMENTSThree (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
Alura Workforce SolutionsHEDIS Clinical Review Nurse, LVN 26-00025 Alura Workforce SolutionsHEDIS Clinical Review Nurse, LVN 26-00025Rancho Cucamonga, CAREQUIREMENTSThree (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
NOR Healthcare SystemsRN Nurse Utilization Review - Full Time, Days (Los Angeles) NOR Healthcare SystemsRN Nurse Utilization Review - Full Time, Days (Los Angeles)Bellflower, CAThe Utilization Review/Management Nurse is also responsible in performing and completing medical necessity reviews utilizing McG and Interqual Review Guidelines ensuring adherence to said guidelines for admission and continued stay reviews. Maintains open lines of communication with Case Managers and Discharge Coordinators to ensure patient's safe and timely transition to the next appropriate level of care based on identified post-acute services needed.
ForhyreTravel RN -Case Management Utilization Review ForhyreTravel RN -Case Management Utilization ReviewLos Angeles, Los Angeles County$1,900–$2,500 / weekThis role is crucial for ensuring that patients receive appropriate care while managing healthcare resources effectively. Communicate effectively with patients, families, and healthcare providers regarding care options and resources.
Centene Corporation GroupClinical Review Clinician Appeals RN Centene Corporation GroupClinical Review Clinician Appeals RNCA$27.02–$48.55 / hourEducation/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience. Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices.
Blue Cross and Blue Shield AssociationMedical Director, Utilization Management - Commercial Prior Authorization Review Blue Cross and Blue Shield AssociationMedical Director, Utilization Management - Commercial Prior Authorization ReviewLong Beach, CADemonstrated proficiency in at least three of the following: MEDICARE/MEDICARE STARS, Dual Special Needs Plan (D-SNP), MEDI-CAL, NCQA/URAC/Quality Programs, Policies/Procedure development, Clinical Subject Matter Expert for Litigation, SIU/Waste/Fraud/Abuse, Appeals/Grievances, Case Management/Population Health, Federal Employee Program (FEP), Education/Training (DELIVERS CME, CEU), Quality Improvement. Support Vice President, Medical Director in strategic initiatives whether by proposing clinical initiatives, providing expert input, shaping the strategy, and/or serving as the initiative driver.
KPC Global MSONewUtilization Review Tech KPC Global MSOUtilization Review TechSanta Ana, CAUnder direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials and mailing/faxing appeals, tracking data from various insurance providers and health plans regarding authorization and/or denials, expedite reviews and documentation to insurance providers. Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plus .
Integrated Resources, IncCare Review Clinician I Integrated Resources, IncCare Review Clinician ILong Beach, CARemote$43–$44 / hourDescription:The Care Review Clinician is responsible for performing utilization management (UM) reviews, including prior authorization of outpatient services, to ensure medical necessity, appropriate level of care, and compliance with regulatory and organizational guidelines. The clinician will review clinical documentation, apply evidence-based criteria, and collaborate with providers to facilitate timely and appropriate care for members.
GallagherVice President, Bill Review and Managed Care GallagherVice President, Bill Review and Managed CareTorrance, CaliforniaRemoteThe actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. With deep expertise in employee benefits, workers’ compensation, loss control, financial services, and property and liability programs, Keenan is dedicated to delivering innovative solutions that protect organizations and empower the communities they serve.
Edwards LifesciencesManager, Clinical Case Review Edwards LifesciencesManager, Clinical Case ReviewIrvine, CAThe Case Review Manager leads the patient screening analysis and evaluation of baseline medical history and clinical imaging reports (e.g EDC screening records including clinic notes, lab results, cardiology assessments, CT and/or echocardiogram reports) to confirm protocol compliance and provide patient screening and case review support to clinical trial sites for Clinical Research Trials within THV Clinical Affairs. + Previous related experience working a clinical setting or equivalent work experience based on Edwards criteria Preferred and Experience working in the setting of a clinical trial or equivalent work experience based on Edwards criteria Preferred.
Sunrise Senior Living LLCNewWellness Nurse LPN LVN Sunrise Senior Living LLCWellness Nurse LPN LVNSan Clemente, CAUnderstand and practice the proper method of attending to and disposing of and the possibility of exposure to blood borne pathogens, bodily fluids, infectious waste, sharp sticks, and hazardous materials in compliance with universal care precautions. Transcribe physician orders Medication Administration Record Treatment Administration Record (MAR/TAR) to include initials, date and time 'noted', and date faxed to pharmacy accurately and promptly.
Neighborhood HealthcareNewRegistered Nurse - Utilization and Care Transitions Neighborhood HealthcareRegistered Nurse - Utilization and Care TransitionsRiverside, CA$50.10–$75.10 / hourThe Utilization Management (UM) and Transitional Care Nurse Navigator/Liaison is responsible for building strong relationships with local hospitals, skilled nursing facilities (SNFs), and other care providers to ensure smooth transitions of care for PACE participants. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to: the candidate's overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs.
Chino Valley Medical CenterNewDischarge Planner II (LVN) - Utilization Management Chino Valley Medical CenterDischarge Planner II (LVN) - Utilization ManagementChino, California$25–$36.21 / hourA nine-time recipient of the Healthgrades Patient Safety Excellence Award (2014-2022), Chino Valley Medical Center has been recognized nationally for its quality, including as among the 100 Great Community Hospitals by Becker’s Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Apidel TechnologiesRegistered Nurse - Case Manager Apidel TechnologiesRegistered Nurse - Case ManagerIrvine, CAContractorSkills/Experience Required: Acute Hospital; Long Term Acute Care/Rehab/Skilled Nursing; Admission Criteria; Care Coordination; Discharge Planning; Utilize InterQual Criteria; Utilize Milliman Guidelines; UR Admission Criteria; UR Appeals and Denials; UR Concurrent Review; UR Continued Stay Reviews; UR Medical Necessity; UR Retrospective Review; UR Utilize InterQual Criteria; UR Utilize Milliman Guidelines; CMS: Centers for Medicare and Medicaid Services; CPT (Current Procedural Terminology) coding and billing; Department of Health; DRG (Diagnosis Related Groups); HEDIS (The Healthcare Effectiveness Data and Information Set) Measures; HIPAA guidelines (Health Insurance Portability and Accountability Act); ICD 10 Coding; NCQA (National Committee for Quality Assurance); OSHA; The Joint Commission/ Core Measure/National Safety Goals. Case Manager and Utilization Review RN for Cancer Specialty Hospital.
Prime Healthcare Services IncNewDischarge Planner II (LVN) Utilization Management Prime Healthcare Services IncDischarge Planner II (LVN) Utilization ManagementChino, CA$25–$36.21 / hourA nine-time recipient of the Healthgrades Patient Safety Excellence Award (2014-2022), Chino Valley Medical Center has been recognized nationally for its quality, including as among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Chino Valley Medical CenterNewCase Manager (RN) - Utilization Management Chino Valley Medical CenterCase Manager (RN) - Utilization ManagementChino, CaliforniaA nine-time recipient of the Healthgrades Patient Safety Excellence Award (2014-2022), Chino Valley Medical Center has been recognized nationally for its quality, including as among the 100 Great Community Hospitals by Becker’s Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.
University Health Services IncRN Clinical Documentation Integrity Specialist - Hybrid University Health Services IncRN Clinical Documentation Integrity Specialist - HybridCORONA, CASouthwest Healthcare is comprised of five acute care hospitals and several non-hospital access points, including: Corona Regional Medical Center, Palmdale Regional Medical Center, Southwest Healthcare Rancho Springs Hospital, Southwest Healthcare Inland Valley Hospital and Temecula Valley Hospital, Temecula Valley Day Surgery, A+ Urgent Care Centers, Apex Heart Specialists, and Riverside Medical Clinics. More information is available on our Benefits Guest Website: UHS Guest Benefits Southwest Healthcare is owned and operated by subsidiaries of Universal Health Services, Inc. (UHS), a King of Prussia, PA-based company, one of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation.
University Health Services IncNewNURSE EDUCATOR University Health Services IncNURSE EDUCATORTORRANCE, CAOperating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdon. Notice At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.
Prime Healthcare Services IncNewCase Manager (RN) Utilization Management Prime Healthcare Services IncCase Manager (RN) Utilization ManagementChino, CARequired Qualifications: Minimum 5 years'' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license At least one year experience in case management, discharge planning or nursing management Experience and knowledge in basic to intermediate computer skills. A nine-time recipient of the Healthgrades Patient Safety Excellence Award (2014-2022), Chino Valley Medical Center has been recognized nationally for its quality, including as among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health.
Montclair Hospital Medical CenterCase Manager (RN) - Utilization Management Montclair Hospital Medical CenterCase Manager (RN) - Utilization ManagementMontclair, California$41.57–$55.95 / hourMontclair Hospital Medical Center is a 106-bed acute care, not-for-profit community hospital, received the “100 Top Hospital” in the nation award from IBM Watson Health, the Patient Safety Excellence award from Healthgrades®, and the Women's Choice Award® for America's Best Emergency Care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.
Integrated Resources, IncTravel: RN Case Manager Days Integrated Resources, IncTravel: RN Case Manager DaysPARAMOUNT, CAMust have mininum 5 years recent RN Case Management experience, with experience in a LTAC or STACH setting, ClientG, discharge planning across acute care settings, strong IDT collaboration. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management and discharge planning.
Impresiv HealthGrievance & Appeals Nurse Impresiv HealthGrievance & Appeals NurseRancho Cucamonga, CARemoteThis role partners closely with internal departments, providers, hospitals, and external agencies to investigate, resolve, and document grievance and appeal cases while supporting continuity of care and member advocacy. The Grievance & Appeals Nurse serves as a clinical resource and subject matter expert for grievance and appeals processes, ensuring timely resolution, regulatory compliance, and quality outcomes for IEHP members.
Mission Palms Healthcare CenterNewRegistered Nurse (RN) AM Shift Mission Palms Healthcare CenterRegistered Nurse (RN) AM ShiftWestminster, CA$45–$55Reviews nurses’ notes to ensure they are accurate/descriptive of the nursing care being provided, including the resident’s responses to the care, and that care is in accordance with the resident’s wishes and physician orders. Serving families throughout Orange County, we provide short-term rehabilitation and long-term care focused on faster recovery, stronger outcomes, and a truly supportive environment.
Impresiv HealthGrievance & Appeals Nurse (LVN) Impresiv HealthGrievance & Appeals Nurse (LVN)Rancho Cucamonga, CARemote$30.72–$39.94 / hourThis role partners closely with IPAs, hospitals, providers, and internal departments to ensure timely resolution of cases, appropriate care coordination, and delivery of high-quality member outcomes. Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services.
NavitasPartnersNewRegistered Nurse – Case Manager - 0605 DS #9 NavitasPartnersRegistered Nurse – Case Manager - 0605 DS #9Mission Viejo, CALocation: Santa Rosa, California | Apple Valley, California | Mission Viejo, California | Mission Hills, California | Eureka, California. Coordinate patient care across the continuum to ensure quality outcomes and efficient resource utilization.
Bienestar Human ServicesNurse Practitioner Bienestar Human ServicesNurse PractitionerPomona, CA$75–$90 / hourEstablish and maintain effective and positive working relationships with representatives of outside agencies, government entities, vendors, as well as other clinical staff, volunteers, and staff; represent the clinic site when appropriate. Straight pulling and pushing; reaching above shoulder; use of fingers; both hands required; walking and standing up to 8 hours; repeated bending; Ability for rapid mental and muscular coordination simultaneously; hearing aid permitted.
Bienestar Human ServicesNurse Practitioner - PT Bienestar Human ServicesNurse Practitioner - PTPomona, CA$75–$90 / hourEstablish and maintain effective and positive working relationships with representatives of outside agencies, government entities, vendors, as well as other clinical staff, volunteers, and staff; represent the clinic site when appropriate. Straight pulling and pushing; reaching above shoulder; use of fingers; both hands required; walking and standing up to 8 hours; repeated bending; Ability for rapid mental and muscular coordination simultaneously; hearing aid permitted.