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 Los Angeles, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $2,065 to $2,160 per week in Los Angeles, CALos Angeles, 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.
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.
Nationwide Therapy GroupTravel Nurse RN - Utilization Review - $1,917 per week in Torrance, CA Nationwide Therapy GroupTravel Nurse RN - Utilization Review - $1,917 per week in Torrance, CATorrance, CA$1,917–$1,917This includes offering exceptional pay packages along with these great benefits: Medical, dental, and vision insurance. NTG is committed to matching you to the right position and we pride ourselves on our commitment to our travelers.
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.
Fusion Medical StaffingNewTravel Cath Lab RN Fusion Medical StaffingTravel Cath Lab RNMission Hills, CA$2,283–$2,624Assist in arterial and/or venous sheath removal using closure devices, manual pressure, or mechanical compression, and transport patients to the appropriate recovery area . Technical/Motor Skills - Must have the ability to grasp, perform fine manipulation, push/pull, and move about when assisting with procedures and/or using department equipment .
SHARP HEALTHCARESRS - Lead – RN - Pediatrics - Full Time - Day Shift SHARP HEALTHCARESRS - Lead – RN - Pediatrics - Full Time - Day ShiftLos Angeles, CA$200,000–$240,000 / 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.
U.S. Renal CareDialysis Registered Nurse U.S. Renal CareDialysis Registered NurseVan Nuys, CA$40.48–$60.71As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease. You'll ensure quality renal care by completing monthly reviews of patient medication profiles and administering medications according to physician orders.
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.
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.
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.
Adventist HealthNewManager RN - Operating Room (OR) Surgery, Full-Time, Day Shift Adventist HealthManager RN - Operating Room (OR) Surgery, Full-Time, Day ShiftGlendale, CAJob Requirements: Education and Work Experience: Bachelor's Degree in nursing or equivalent combination of education/related experience: Required Master's Degree: Preferred Five years' technical experience: Preferred One year's leadership experience: Preferred Two years' experience of acute care nursing in hospital setting: Preferred Licenses/Certifications: Registered Nurse (RN) licensure in the state of practice: Required Cardiopulmonary Resuscitation (CPR) or Basic Life Support (BLS OR HS-BLS OR RQIBLS) certification: Preferred National specialty certification in area of expertise or in nursing administration: Preferred Facility Specific License/Certifications: Basic Life Support (BLS OR HS-BLS OR RQI BLS) certification: Required Essential Functions: Builds a high performing clinical work team by recruiting and retaining skilled professional staff. Initiates and coordinates individual and team conferences with health team members, patients, and/or families to initiate and revise care plans for optimal, individualized patient care as per care setting.
Los Angeles CountyUTILIZATION REVIEW NURSE SUPERVISOR II Los Angeles CountyUTILIZATION REVIEW NURSE SUPERVISOR IILos Angeles, CA$118,457.04–$177,314.88 / yearVeteran's Credit: Pursuant to the County Charter and County policy, in all open competitive examinations (i.e., examinations open to everyone), the County of Los Angeles will add a credit of 10 percent of the total credits specified for such examination to the final passing score of an honorably discharged veteran, as well as the spouse of a deceased or disabled veteran, who served in the Armed Forces of the United States under specific conditions. Under the direction of a physician member of the Utilization Review Committee, the incumbent is responsible for the development and implementation of procedures for and the effective conduct of the system to review patients medical charts to ascertain the medical necessity for services and appropriateness of the level of care, for notification of appropriate persons of cases which do not meet medical necessity and level of care criteria, and for certification of approved hospital days reimbursable under the Medicare and MediCal programs.
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) .
NeueHealthNewConcurrent Utilization Review Nurse, RN NeueHealthConcurrent Utilization Review Nurse, RNLos Angeles, CA$74,286.15–$111,429.23 / yearBy uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid. This role involves assessing inpatient admission and continued stays, coordinating with healthcare providers, facilitating communication with payers, and ensuring compliance with health plan policies and clinical guidelines.
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.
Providence St. Joseph HealthUtilization Review RN Providence St. Joseph HealthUtilization Review RNMission Hills, CATogether, 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. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence Health & ServicesUtilization Review RN Providence Health & ServicesUtilization Review RNMission Hills, CA$57.28–$88.92 / hourTogether, 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. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
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.
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 & 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 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.
UCLA Health SystemQuality Management Clinical Nurse - Facility Site Review UCLA Health SystemQuality Management Clinical Nurse - Facility Site Reviewlos angeles, CA$37.60–$78.35 / hourIn this role, you will supports all Medical Group Health Education & Disease Management Programs utilizing established interventions, performing necessary surveys acting as the primary liaison between providers and office staff and Health Plans to facilitate appropriate Health Education opportunities. Additionally, you will performs HEDIS related activities, Pay for Performance activities, Provider Access and Availability Surveys (PAAS), investigates and resolves access-related patient issues, and develops QI reports and action plans, as necessary.
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.
Vivo HealthStaffUtilization Review Clinical Manager - Denials (Registered Nurse) Vivo HealthStaffUtilization Review Clinical Manager - Denials (Registered Nurse)Burbank, CAVivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States. Oversee both licensed and non-licensed denial unit staff, managing daily tasks, performance reviews, and any necessary disciplinary actions.
Vivo HealthStaffUtilization Review Clinical Supervisor - Denials (Registered Nurse) Vivo HealthStaffUtilization Review Clinical Supervisor - Denials (Registered Nurse)Burbank, CAVivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States. Supervise licensed and non-licensed denial unit staff, managing daily tasks, performance reviews, and disciplinary actions.
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.
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.
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.
Molina Healthcare IncRN- Care Review Clinician- Utilization Review (Remote- CA License Req) Molina Healthcare IncRN- Care Review Clinician- Utilization Review (Remote- CA License Req)Los Angeles, CARemoteResponsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
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 ReviewWoodland Hills, 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.
Centene Corporation GroupNewUtilization Review Clinician - ABA Centene Corporation GroupUtilization Review Clinician - ABALos Angeles, CARemote$27.02–$48.55 / hourRN - Registered Nurse - State Licensure and/or Compact State Licensure RN - Registered Nurse- State Licensure and/or Compact State Licensure with BCBA required or. Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services.
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.
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 .
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.
UCLA Health SystemUtilization Management Nurse UCLA Health SystemUtilization Management NurseLos Angeles, CA$74.16–$107.75 / hourb'nn n n n n n n n n n n n nn n n n n n n n n n n n n n n n n n Utilization Management Nurse - - 30401 - UCLA Healthn n nnnn nn n n n nn nn n n Skip to content nnnnn nn UCLA Health Home Pagen nnn nnnn nnn Main menu. Press enter or space keys to expands and escape key to collapsennn nnn n n Search jobs n n nnn n n Employee Res...
Sunrise Senior LivingNewWellness Nurse LPN LVN Sunrise Senior LivingWellness Nurse LPN LVNSan Clemente, CaliforniaUnderstand 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. COMMUNITY NAME: San Clemente Villas Job ID: 2026-242408 JOB OVERVIEW: The Wellness Nurse is responsible for monitoring the health and well-being of our residents and provides leadership support and assistance with resident care and services.
NeueHealthNewUtilization Management Nurse, LVN/LPN NeueHealthUtilization Management Nurse, LVN/LPNLos Angeles, CA$26.35–$39.53 / hourBy uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid. This role involves assessing inpatient admission and continued stays, coordinating with healthcare providers, facilitating communication with payers, and ensuring compliance with health plan policies and clinical guidelines.
West Valley Post AcuteIP Nurse West Valley Post AcuteIP NurseWest Hills, CAFull timeCare Plan Functions Assist in the development, implementation, and maintenance of a written plan of care (preliminary and comprehensive) for each resident in isolation or on infection control precautions that identifies the problems/needs of the resident, indicates the care to be given, goals to be accomplished, and which professional service is responsible for each element of care. Orient new employees to the importance of infection control policies and procedures, personal hygiene, handwashing/hand hygiene techniques, etc., as well as the employee's responsibility in following our established procedures for tasks involving exposure to blood/body fluids.
Macpower Digital Assets Edge Private LimitedUtilization Management Policy Initiatives Registered Nurse Macpower Digital Assets Edge Private LimitedUtilization Management Policy Initiatives Registered NurseLos Angeles, CA$102,183–$132,838 / yearThis role ensures that the day to day functions of Utilization Management initiatives comply with regulatory and accreditation requirements such as those stated in contracts, CalAIM Population Health Management (PHM) Policy Guide, National Committee on Quality Assurance (NCQA) Department of Health Care Services (DHCS) All Plan Letters (APLs), and Centers for Medicare and Medicaid Services (CMS) Model of Care (MOC) through sound clinical policy maintenance. Non-negotiable requirements of this position: Direct past experience with Health Care / Medical Policy work specifically within a Managed Care Plans environment; experience with the ongoing development of the Medical Policy review process including clinical and utilization data analysis; Assisted in developing training documents and presentations for new and/or revised Medical Policies to internal stakeholders.
UCLA Health SystemUtilization Management Manager, Medicare Advantage - RN UCLA Health SystemUtilization Management Manager, Medicare Advantage - RNlos angeles, CA$112,900–$256,900 / yearAs a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer. Named one of the top hospitals in the nation by U.S. News & World Report, UCLA Health features four award-winning hospitals and more than 250 community clinics throughout Southern California as well as the David Geffen School of Medicine.
Presidential Staffing Solutions, LLCUtilization Management Nurse Presidential Staffing Solutions, LLCUtilization Management NurseLos Angeles, CAFor Inpatient RNs, performs unit based inpatient case management duties, with the ability to perform RN case management assessments, discharge planning, formulating safe plans of care and anticipating patient care needs. The incumbent consistently communicates and treats the Veteran and as appropriate the Veteran’s family, caregiver and/or significant other, the Veteran representatives, visitors to VA facilities, all VA staff, and other customers in a courteous, tactful, and respectful manner.
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. Description: Complex inpatient Case Manager and Utilization Review RN for Cancer Specialty Hospital.
NeueHealthNewUtilization Management Nurse, LVN/LPN (Work from Home) NeueHealthUtilization Management Nurse, LVN/LPN (Work from Home)Los Angeles, CA$27.10–$40.65 / hourBy uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid. Working in collaboration with Medical Directors and the clinical team, the PA Nurse ensures members receive the appropriate benefit coverage for services requiring prior authorization.
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.