NewTravel Nurse RN - Utilization Review - $2,248 to $2,343 per week in Marina del Rey, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $2,248 to $2,343 per week in Marina del Rey, CAMarina del Rey, CA$2,248–$2,343As 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.
Travel 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$1,917This 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.
NewLocal Contract Nurse RN - Acute Care Case Management - $87 per hour LanceSoftLocal Contract Nurse RN - Acute Care Case Management - $87 per hourWoodland Hills, CALanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.
NewLocal Contract Nurse RN - Case Management - $87 per hour LanceSoftLocal Contract Nurse RN - Case Management - $87 per hourWoodland Hills, CALanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.
Grievance and Appeals Nurse Specialist (LVN or RN) Kinetic Personnel GroupGrievance and Appeals Nurse Specialist (LVN or RN)Orange, CA$43–$65 / hourTemporaryUtilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment. A permanent position does include excellent CalPERS pension, 401a (4% contribution) and excellent government benefits and Holiday/PTO schedule.
NewTravel RN Case Manager - $2,640 per week LanceSoftTravel RN Case Manager - $2,640 per weekSanta Monica, CALanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.
NewPsychiatrist JobotPsychiatristLos Angeles, CA$220,000–$260,000 / yearKey services include housing, mental health care, medical care, domestic violence services, substance abuse treatment, income assistance and life skills programs --- all aimed at improving the self-sufficiency of the individuals and families served. Evaluates clients by interviewing client, family, and other persons; conducting physical examinations; observing behaviors; reviewing medical history and related documents; selecting, administering, and interpreting psychological tests; and ordering laboratory tests and evaluating results.
NewTravel Nurse RN - Nurse Manager - $2,151 per week in Los Angeles, CA TravelNurseSourceTravel Nurse RN - Nurse Manager - $2,151 per week in Los Angeles, CALos Angeles, CA$2,151Job Title: Emergency Department Nurse Lead Profession: RN Specialty: Nurse Lead Duration: 13 weeks Shift: Night Shift Hours per Shift: 36 hours Experience: Minimum five years of technical experience preferred License: Registered Nurse (RN) licensure in the state of practice required Certifications: Cardiopulmonary Resuscitation (CPR) certification or Basic Life Support (BLS) certification preferred Must-Have: Supervisory experience or demonstrated supervisory skills required Description: Provides unit-based leadership working collaboratively with the Nurse Manager, Director, Physicians, and staff. Ensures that all patients receive cost-effective, professional care that results in positive outcomes and high patient satisfaction while maintaining the highest level of patient safety.
NewSRS - 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.
NewTravel Nurse RN - Care Manager - $3,803 per week LanceSoftTravel Nurse RN - Care Manager - $3,803 per weekWoodland Hills, CALanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.
NewTravel Nurse RN - Case Manager - $2,362 per week in Torrance, CA TravelNurseSourceTravel Nurse RN - Case Manager - $2,362 per week in Torrance, CATorrance, CA$2,362Job Title: Case Manager Profession: Nursing Specialty: Case Management Duration: 14 weeks Shift: 5x8.0 Hours per Shift: 8.0 Experience: Minimum of 2 years clinical experience; 2 years of Case Management experience or certification in Case Management License: Current RN license Certifications: Current BCLS certification Must-Have: Utilization Review experience Description: This position reports to the Director of Case Management. Performs chart reviews and quality assessments on all patients using Severity of Illness and Intensity of Service criteria as directed by Administration and the Medical Staff.
NewSRS -RN -Oncology Frost Street - Full Time - Day Shift SHARP HEALTHCARESRS -RN -Oncology Frost Street - Full Time - Day ShiftLos Angeles, 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. See Sharp HealthCare Terms & Conditions at https://www.sharp.com/patient-rights-privacy/terms-of-use.cfm and Privacy Policy at https://www.sharp.com/patient-rights-privacy/privacy-practices.cfm and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.
Utilization 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.
Utilization Management Nurse Presidential Staffing SolutionsUtilization Management NurseLos Angeles, CaliforniaFor 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.
Utilization Management - RN Impresiv HealthUtilization Management - RNLong Beach, CARemoteIn this role, you will perform concurrent reviews, prior authorizations, medical necessity reviews, discharge planning, and transitions of care while collaborating with physicians, hospitals, and interdisciplinary teams to ensure members receive appropriate, cost-effective, and evidence-based care. Impresiv Health is a healthcare consulting partner specializing in clinical and operations management, enterprise project management, professional services, and software consulting services.
Utilization 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.
Registered Nurse - Utilization Management myPlace Care PartnersRegistered Nurse - Utilization ManagementLos Angeles, CaliforniaWorking within the Health Plan Department, the Utilization Management Nurse partners with the Interdisciplinary Team, providers, contracted facilities, and internal stakeholders to support authorization processes, care coordination, utilization review, and documentation accuracy. As a PACE (Program of All Inclusive Care for the Elderly) organization backed by SCAN Group, myPlace Health brings together customized medical care, social activities, and daily support for participants and their families – all under one roof.
RN Utilization Management Nurse (InPatient) - California Commercial Elevance HealthRN Utilization Management Nurse (InPatient) - California CommercialWoodland Hills, CaliforniaThe Medical Management Nurse for California HMO is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as medically necessary. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Utilization Review LPN LVN - Utilization Management Providence Health & ServicesUtilization Review LPN LVN - Utilization ManagementMission 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. Required Qualifications: Associate''s Degree in Healthcare or high school diploma or GED with graduation from an accredited nursing program from a college or vocational school with 2 years' related work experience.
Utilization Review LPN LVN - Utilization Management Providence St. Joseph HealthUtilization Review LPN LVN - Utilization ManagementMission 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. Required Qualifications: Associate''s Degree in Healthcare or high school diploma or GED with graduation from an accredited nursing program from a college or vocational school with 2 years' related work experience.
Manager, Utilization Management Nurse Management Blue Cross and Blue Shield AssociationManager, Utilization Management Nurse ManagementWoodland Hills, CAThe Utilization Management team reviews inpatient stays and prior authorization for our members and correctly applies the guidelines for nationally recognized levels of care for both our Medi-Cal and Medicare populations. Demonstrated experience with basic management approaches such as work scheduling, prioritizing, coaching, process execution, work organization, inventory management, risk management and delegation.
NewUtilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantCA$26.01–$62.32 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
Utilization Management Nurse Specialist RN II L.A. Care Health PlanUtilization Management Nurse Specialist RN IILos Angeles, CAPerforms telephonic and/or onsite admission and concurrent review, and collaborates with onsite staff, physicians, providers, member/family interaction to develop and implement a successful discharge plan. Receives incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps.
Utilization 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.
Utilization Management Nurse I, RN Clever Care Health Plan IncUtilization Management Nurse I, RNHuntington Beach, CARemote$34.98–$42.85 / hourAt Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
NewUtilization Management Policy Initiatives Registered Nurse Macpower Digital Assets Edge Private LimitedUtilization Management Policy Initiatives Registered NurseLos Angeles, CARemote$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.
Utilization Management Nurse, LVN/LPN NeueHealth IncUtilization Management Nurse, LVN/LPNCA$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. 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.
Supervisor, Utilization Management (RN) Centene Corporation GroupSupervisor, Utilization Management (RN)CA$75,300–$135,400 / yearEducates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers. Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
Utilization Management Nurse, Senior Blue Cross and Blue Shield AssociationUtilization Management Nurse, SeniorLong Beach, CAThe Utilization Management team independently manages complex utilization and retrospective clinical reviews across multiple lines of business, assessing medical necessity, coding accuracy, treatment plans, discharge planning, and compliance requirements while supporting clinical consistency, process improvement, quality, timeliness, and appropriate escalation of high-risk cases. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Case Manager (RN) Utilization Management Prime Healthcare Services IncCase Manager (RN) Utilization ManagementSan Dimas, CA$41.57–$55.95 / 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. San Dimas Community Hospital has received multiple awards including the "100 Top Hospitals," Women''s Choice Award for America''s Best Hospitals for Patient Safety, and Healthgrades awards, including the "Patient Safety Excellence Award."
NewED Case Management Utilization RN, PD Day Kaiser PermanenteED Case Management Utilization RN, PD DayDowney, CAReviews, analyses and identifies utilization patterns and trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities. Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families.
ED Case Management Utilization RN, Per Diem Night 10/hr Shift Kaiser PermanenteED Case Management Utilization RN, Per Diem Night 10/hr ShiftDowney, CAReviews, analyses and identifies utilization patterns and trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities. Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families.
ED Case Management Utilization RN, PD Mid-shift Kaiser PermanenteED Case Management Utilization RN, PD Mid-shiftBaldwin Park, CA$72.95–$89.28 / hourFor-jobs-where-work-will-be-performed-in-unincorporated-LA-County,-the-employer-provides-the-following-statement-in-accordance-with-the-Los-Angeles-County-Fair-Chance-Ordinance.-Criminal-history-may-have-a-direct,-adverse,-and-negative-relationship-on-the-following-job-duties,-potentially-resulting-in-the-withdrawal-of-the-conditional-offer-of-employment: Consistently-supports-compliance-and-the-Principles-of-Responsibility-(Kaiser-Permanente's-Code-of-Conduct)-by-maintaining-the-privacy-and-confidentiality-of-information,-protecting-the-assets-of-the-organization,-acting-with-ethics-and-integrity,-reporting-non-compliance,-and-adhering-to-applicable-federal,-state,-and-local-laws-and-regulations,-accreditation,-and-licensure-requirements-(where-applicable),-and-Kaiser-Permanente's-policies-and-procedures. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment: Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.
Discharge Planner II (LVN) Utilization Management Prime Healthcare Services IncDischarge Planner II (LVN) Utilization ManagementSan Dimas, CA$25–$36.21 / hourSan Dimas Community Hospital has received multiple awards including the "100 Top Hospitals," Women''s Choice Award for America''s Best Hospitals for Patient Safety, and Healthgrades awards, including the "Patient Safety Excellence Award." 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.
Utilization Management Admissions Liaison RN II L.A. Care Health PlanUtilization Management Admissions Liaison RN IILos Angeles, CAProvides the primary clinical point of contact for inpatient acute care hospitals requesting Inpatient care/post-stabilization admission requests, Higher level of care transfers and other emergent transfers or needs. Utilizes clinical judgement, independent analysis, critical-thinking skills, detailed knowledge of medical policies, clinical guidelines and benefit plans to complete reviews and determinations within required turnaround times specific to the case type.
NewRegistered Nurse- Utilization Management HJ StaffingRegistered Nurse- Utilization ManagementLong Beach, CAYou will collaborate closely with physicians, hospitals, and interdisciplinary teams to ensure members receive appropriate, cost-effective, and evidence-based care. Documentation & Escalation: Request and review additional clinical documentation as needed; escalate complex medical necessity cases to the Medical Director.
NewCase Manager (RN) - Utilization Management San Dimas Community HospitalCase Manager (RN) - Utilization ManagementSan Dimas, California$41.57–$55.95 / hourTemporaryThe 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. San Dimas Community Hospital has received multiple awards including the "100 Top Hospitals," Women's Choice Award for America's Best Hospitals for Patient Safety, and Healthgrades awards, including the "Patient Safety Excellence Award."
Discharge Planner II (LVN) - Utilization Management San Dimas Community HospitalDischarge Planner II (LVN) - Utilization ManagementSan Dimas, California$25–$36.21 / hourFull timeSan Dimas Community Hospital has received multiple awards including the "100 Top Hospitals," Women's Choice Award for America's Best Hospitals for Patient Safety, and Healthgrades awards, including the "Patient Safety Excellence Award." 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.
Supervisor, Utilization Management RN L.A. Care Health PlanSupervisor, Utilization Management RNLos Angeles, CAThis includes, but not limited to, ensuring proper staffing and coverage; monitoring and evaluating departmental operations to ensure optimal efficiency, productivity, and effectiveness; documenting and appropriately addressing excellence or deviations in work, departmental, and organizational expectations; and conducting intermittent and annual performance evaluations. The Supervisor ensures all functions of the UM department are operating in accordance with the organizations mission, values and strategic goals, which are focused on quality care delivery and continuous improvement; and are provided in a manner that is responsive and sensitive to the needs of L.A.
Utilization Management Assistant Director - RN UCLA Health SystemUtilization Management Assistant Director - RNLos Angeles, CA$116,300–$264,600 / yearHighly organized, reliable, consistently seeking learning opportunities and new challenges, High EQ, communication skills, problem solving ability, and teamwork, humble yet confident, peers feel comfortable requesting your assistance. UCLA Health is seeking a dynamic and experienced Utilization Management Assistant Director to oversee Intensive Case Management (ICM) and Utilization Management (UM) operations focused on high-risk and complex patient populations.
LVN - 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.
RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Emanate Health Medical CenterRN - Quality Assurance/Utilization Review - Business Development - Full Time 8hrCovina, CA$52.03–$80.64 / 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.
Director of Case Management Utilization Management Prime Healthcare Services IncDirector of Case Management Utilization ManagementInglewood, CA$108,160–$163,800 / yearAn award-winning facility, ranking in the top 5% nationally for quality and patient safety, Centinela Hospital is a 362-bed acute-care hospital with a 24-hour STEMI certified emergency department and primary stroke center, orthopedic care, advanced cardiac services, critical care services, inpatient and outpatient rehab programs, and more. Preferred leadership style and ideal candidate is a forward-thinking professional who thrives in a collaborative, fast-paced healthcare setting and is passionate about driving positive patient outcomes and reducing readmissions.
RN 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.
Director of Case Management - Utilization Management Centinela Hospital Medical CenterDirector of Case Management - Utilization ManagementInglewood, California$108,160–$163,800 / yearFull timeAn award-winning facility, ranking in the top 5% nationally for quality and patient safety, Centinela Hospital is a 362-bed acute-care hospital with a 24-hour STEMI certified emergency department and primary stroke center, orthopedic care, advanced cardiac services, critical care services, inpatient and outpatient rehab programs, and more. Preferred leadership style and ideal candidate is a forward-thinking professional who thrives in a collaborative, fast-paced healthcare setting and is passionate about driving positive patient outcomes and reducing readmissions.
Senior Clinical Utilization Review Nurse I Kaiser PermanenteSenior Clinical Utilization Review Nurse IPasadena, CAFacilitates quality improvement efforts by: conducting advanced data analyses and developing reports to identify utilization patterns, trends, and opportunities for improvement; providing input and participating in the implementation of corrective action plans to address deficiencies and evaluate effectiveness in utilization review workflows/processes; actively adhering to utilization policies, procedures, and guidelines to ensure compliant and cost-effective care; and developing, refining, and providing oversight for desk-level procedures (e.g., workflows). + Provides high-quality consultation by: leading communication efforts with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care and resolving communication issues within the work team; and leveraging advanced knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians.
RN Case Manager - Utilization Review St. Francis Medical CenterRN Case Manager - Utilization ReviewLynwood, California$47.20–$63.45 / hourFull timeThe 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. 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.
RN 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.