GQR HealthcareNewTravel Nurse RN - Utilization Review - $2,065 to $2,160 per week in Los Angeles, CA GQR HealthcareTravel 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.
GQR HealthcareNewTravel Nurse RN - Utilization Review - $2,211 to $2,306 per week in Fountain Valley, CA GQR HealthcareTravel Nurse RN - Utilization Review - $2,211 to $2,306 per week in Fountain Valley, CAFountain Valley, CA$2,211–$2,306As 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.
U.S. Renal CareDialysis Registered Nurse U.S. Renal CareDialysis Registered NurseNorth Hollywood, CA$41.97–$62.95As 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.
Adventist HealthNewManager RN - Operating Room (OR) Surgery, Full-Time, Day Shift Adventist HealthManager RN - Operating Room (OR) Surgery, Full-Time, Day ShiftGlendale, CAInitiates 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. We are comprised of a 515-bed hospital, two urgent cares, home care services, comprehensive cardiology care and a vast scope of services located in the San Fernando Valley.
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.
SHARP HEALTHCARENewSRS - Lead – RN - Pediatrics - Full Time - Day Shift SHARP HEALTHCARESRS - Lead – RN - Pediatrics - Full Time - Day ShiftOrange, CA$53,200–$63,840 / 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.
Providence Health and ServicesNewCare Manager RN Full- time Variable Providence Health and ServicesCare Manager RN Full- time VariableTarzana, CA$57.99–$87.70 / hourOur 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. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care.
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.
Huntington HospitalNewClinical Nurse Specialist, Adult Huntington HospitalClinical Nurse Specialist, AdultPasadena, CA$146,984–$224,158 / yearCNSs are one of four categories of APRNs as identified by the APRN Consensus Model, National Council of State Boards of Nursing (NCSBN), State Boards of Nursing, American Nurses Association (ANA) and International Council of Nurses (ICN). The CNS provides expert comprehensive nursing care directly to patients, supports and develops registered nurses at the point of care and serves as a leader in redesigning systems to improve access, quality, and safety in a cost-effective manner.
Cherokee FederalNewNurse Practitioner, APRN, FNP Cherokee FederalNurse Practitioner, APRN, FNPLos Angeles, CA$120,000–$130,000Assesses all body systems, determines the need for additional exams, communicates abnormal findings to applicants, and updates medical staff for accurate database documentation. As a trusted partner for more than 60 federal clients, Cherokee Federal LLC is focused on building a brighter future, solving complex challenges, and serving the government’s mission with compassion and heart.
University of CaliforniaUtilization Review Nurse University of CaliforniaUtilization Review NurseLos Angeles, CA$74.16–$107.75 / hourAs a condition of employment, the final candidate who accepts an 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; or have filed an appeal of a finding of substantiated misconduct with a previous employer. The Utilization Review Nurse is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital, supporting inpatient, partial hospital, and intensive outpatient programs.
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.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.
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.
Los Angeles CountyUTILIZATION REVIEW NURSE SUPERVISOR I Los Angeles CountyUTILIZATION REVIEW NURSE SUPERVISOR ILos Angeles, CA$111,656.88–$167,136.48 / 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. Requirements SELECTION REQUIREMENTS:OPTION I: One year of experience performing the duties of a Utilization Review Nurse or Medical Service Coordinator, CCS.-OR-OPTION II: Two (2) years of experience as a registered nurse, of which one year must be in the treatment of chronic and short- term medical and surgical inpatient problems, AND one (1) year of experience in the first-level supervision of registered nurses and other nursing staff.
Astrana Health IncUM Review Nurse - LVN Astrana Health IncUM Review Nurse - LVNMonterey Park, CARemoteIn this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. We are seeking nurses with at least one year of outpatient UM experience in a fast-paced setting.
NeueHealth IncConcurrent Utilization Review Nurse, RN NeueHealth IncConcurrent Utilization Review Nurse, RNCalifornia, 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. Job Summary: The Concurrent Utilization Review (UR) Nurse is responsible for conducting real-time clinical reviews to ensure the medical necessity and appropriateness of healthcare services provided to members under a managed care health plan.
L.A. Care Health PlanUtilization Management Claims Review Nurse RN II L.A. Care Health PlanUtilization Management Claims Review Nurse RN IILos Angeles, CAPerform claims pre-payment review by supporting the Claims team in evaluating flagged claims prior to adjudication to ensure services are medically necessary, documentation supports billed services, coding is accurate and aligned with authorization when applicable, and unnecessary denials are reduced through accurate clinical validation. This position supports payment integrity initiatives through retrospective and pre-payment review processes, helps reduce unnecessary denials, and monitors for potential fraud, waste, and abuse (FWA).
Blue Cross and Blue Shield AssociationUtilization Management Nurse, Senior- Medicare Concurrent Review Blue Cross and Blue Shield AssociationUtilization Management Nurse, Senior- Medicare Concurrent ReviewWoodland Hills, CARequires a current California RN License Requires at least 5 years of prior relevant experience Requires strong communication and computer navigation skills Desires strong teamwork and collaboration skills Requires independent motivation and strong work ethic Requires strong critical thinking skills Hybrid Virtual Work This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need. Your Work In this role, you will: Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC and CMS evidenced based guidelines, policies and nationally recognized clinal criteria for BSC Medicare line of business.
Emanate Health Medical CenterLVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Emanate Health Medical CenterLVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hrCovina, CA$31.03–$46.54 / hourComplete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings. On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.
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 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.
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 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.
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.
University of CaliforniaQuality Management Clinical Nurse - Facility Site Review University of CaliforniaQuality 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.
Prime Healthcare Services IncRN Case Manager Utilization Review Prime Healthcare Services IncRN Case Manager Utilization ReviewLynwood, CA$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.
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 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 HealthRN 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.
Providence Health & ServicesRN Utilization Review - Part-time - REMOTE Providence Health & ServicesRN Utilization Review - Part-time - REMOTEMission Hills, CARemote$57.28–$88.92 / hourRequsition ID: 434156 Company: Providence Jobs Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Part time Job Shift: Day Career Track: Nursing Department: 7000 UTILIZATION MGMT REMOTE Address: CA Mission Hills 15031 Rinaldi St Work Location: Providence Holy Cross Medical Ctr-Mission Hills 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.
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.
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.
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.
UCLA Health SystemClinical Data Review Coordinator UCLA Health SystemClinical Data Review CoordinatorSanta Monica, CA$54,400–$208,300 / 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. Your work ensures that the data driving our quality metrics is reliable, actionable, and aligned with regulatory expectations-ultimately supporting better outcomes for the patients and communities we 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.
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.
Ascend Learning LLCLive Review Educator Part Time Ascend Learning LLCLive Review Educator Part TimeCalifornia, CACompleted Master's Degree in Nursing (MSN) required • Active Registered Nursing License • Knowledge of NCLEX Blueprint • Minimum 2 years of experience teaching nursing academics in a College/University setting • 5+ years preferred • Academic teaching experience in a college/university required, within the last 12 months preferred • Knowledge of ATI Products preferred • A computer with reliable internet access • Demonstrate an engaging presentation style • Exhibit professionalism • Demonstrate technological competence with a variety of applications • Create a collaborative atmosphere with faculty and students • Communicate clear expectations and establish realistic goals • Guide students to identify their personal learning needs • Challenge and support students to exercise critical-thinking skills • Creatively provide and clarify essential content • Use a variety of interactive presentation strategies. Headquartered in Burlington, MA, with additional office locations and hybrid and remote workers in cities across the U.S., Ascend Learning was recognized by Newsweek and Plant-A Insights Group as one of America's 2025 Greatest Workplaces as well as America's Best Places to work for Mental Well-Being for 2025.
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.
Molina Healthcare IncSpecialist, Facility Site Review (must reside in California) Molina Healthcare IncSpecialist, Facility Site Review (must reside in California)Los Angeles, CAProvides support for facility site review activities including routine document preparation and file management, site review meeting/travel scheduling, and office supply ordering. Conducts outreach to providers to schedule facility site reviews; leverages established departmental workflows and job aids in all outreach efforts.
L.A. Care Health PlanManager, Utilization Management Claims Review L.A. Care Health PlanManager, Utilization Management Claims ReviewLos Angeles, CAThe Manager, Utilization Management Claims Review partners with internal departments and executive leadership to promote effective workflows, mitigate fraud, waste, and abuse (FWA), and support high-quality, cost-effective care delivery and organizational performance goals. Oversee workflow and queue management to ensure claims and PDR requests are completed within required regulatory timeframes, including monitoring workload distribution.
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 .
Molina Healthcare IncCare Review Clinician, RN/LPN Molina Healthcare IncCare Review Clinician, RN/LPNLong Beach, CAResponsible 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 health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Alignment Healthcare IncUtilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License) Alignment Healthcare IncUtilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)CARemote$85,696–$128,543 / yearServes as first-line SME/resource for inpatient UM questions Provides 1:1 coaching/shadowing support when needed Available and approachable/supportive while still helping to maintain accountability Provides guidance to staff or directly manages complicated requests from members, providers, or staff. Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.
Mid-Columbia Medical CenterRN, Nurse Lead (Charge Nurse) NICU, Full Time, Day Shift Mid-Columbia Medical CenterRN, Nurse Lead (Charge Nurse) NICU, Full Time, Day Shiftglendale, CAAssigns staff to particular patients and patient care activities according to independent professional and supervisory analysis/assessment of the most effective utilization of skills and abilities, patient needs, and to equalize work loads of assigned personnel. Ensures compliance with Patient Safety Goals as identified by The Joint Commission, hospital policy, Quality Measures, and Patient Safety initiatives through unit management and participation in hospital Performance Improvement (PI) Teams.
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.
The Gardens Healthcare CenterNewRegistered Nurse (RN) The Gardens Healthcare CenterRegistered Nurse (RN)Los Angeles, CA$40–$65Serving families throughout Los Angeles County, we provide short-term rehabilitation and long-term care focused on faster recovery, stronger outcomes, and a truly supportive environment. Reviews 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.