- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and… more
- Elevance Health (Woodland Hills, CA)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Dignity Health (Northridge, CA)
- …setting required. + Current CA Registered Nurse (RN) license + Prior Utilization Management experience in a clinical or insurance setting required. + ... 400 care centers. Visit dignityhealth.org/northridgehospital for more information. The RN Utilization Management Coordinator (UMC) is responsible for assessing… more
- Elevance Health (Los Angeles, CA)
- ** Nurse Reviewer I** **Location:** Within 50 miles of...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-10 + Previous utilization … more
- Elevance Health (Woodland Hills, CA)
- ** Nurse Reviewer I** **Location:** Within 50 miles of...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- UCLA Health (Los Angeles, CA)
- …of Hepatobiliary disease. Additional responsibilities include data collection for clinical management . The Liver Cancer Clinical Nurse reports directly to ... Description The Liver Cancer Clinical Nurse is a professional registered nurse who assumes responsibility and accountability for patients within the… more
- Guidehouse (Los Angeles, CA)
- …two years' experience in nursing or one-year related nursing experience in utilization review /insurance/case management /medical clearance. * Graduation from ... **Job Family** **:** Patient Access Nurse **Travel Required** **:** None **Clearance Required** **:**...Nice To Have** **:** * Two years' experience in utilization review with external payors within a… more
- Molina Healthcare (Long Beach, CA)
- …are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review / Utilization Review / Utilization Management and ... **JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE ** **For this...or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current… more
- LA Care Health Plan (Los Angeles, CA)
- …in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The expected pay range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
- The County of Los Angeles (Los Angeles, CA)
- …the following: + Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT ... the work of staff, and evaluating employee performance. For this examination, Utilization Review is defined as provides technical and administrative direction… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the RN Asst. Director for Utilization Review , Intensive Case Management , you will support and perform duties to provide ... discharge planning/ UM concurrent review of the complex cases admitted in Non Domestic...BSN Degree + Minimum of 2 years' experience in utilization management , Inpatient CM or clinical Experience… more
- LA Care Health Plan (Los Angeles, CA)
- …Clinical Auditor RN II is responsible for ensuring that delegates contracted to perform Utilization Management (UM) functions on behalf of LA Care (LAC) is in ... also acts as a liaison between the Plan Partners, PPGs and Vendors regarding Utilization Management (UM) issues; assists in improving access and utilization … more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestricted California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Manager, Enhanced Care Management (RN or LCSW) Job Category: Clinical Department:...ECM services to medically and behaviorally complex members. + Review systems and processes, making recommendations for improvement to… more
- LA Care Health Plan (Los Angeles, CA)
- …by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health ... Care Management Specialist II Job Category: Clinical Department: Care...Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse (RN);current and unrestricted California License OR Licensed Clinical… more
- LA Care Health Plan (Los Angeles, CA)
- …for oversight and adequate performance of delegated activities. Collaborates with Utilization Management (UM), Provider Network Operations and Quality Dept.'s ... or health care with a focus in areas of Utilization Management claims. At least 3-5 years...Active, current and unrestricted California License Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM)… more
- Pipeline Health System, LLC (Gardena, CA)
- …performs a wide variety of tasks and functions. These include utilization review , discharge planning, care coordination and variance management to assure the ... team to ensure coordination of patient care and wise utilization of resources. + Documents case management ...interdisciplinary team. Communicates expected discharges to the unit charge nurse , patient unit and family. + Identifies patients at… more
- Emanate Health (Covina, CA)
- …of California, and hospital policies, goals, and objectives. Completes Utilization Review of Behavioral Health Services. Charge Nurse will have expert ... care providers. Provides patient care as needed. The Charge Nurse is responsible for the internal management of the nursing unit functions and staff, along with… more
- Cedars-Sinai (Beverly Hills, CA)
- …budgets. + Executes on leader standard work. Meets requirements for Daily Management Systems. Monitors organizational metrics with review and analysis in ... oversight and management of efficiency. Participates in the evaluation and review of all human resources and communicates issues appropriately and partners with… more