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Utilization Review Rn Jobs in California

Utilization Review Jobs
By CodeMax Medical Billing At Los Angeles, CA, United States

The Utilization Review Specialist will perform utilization review of pre-certification and concurrent clinical utilization reviews with insurance companies in accordance with certification ...

Concurrent Review Nurse, Rn - 23-246
By Hill Physicians Medical Group At , Sacramento

We’re delighted you’re considering joining us!

Rn Utilization Review Specialist - Case Management
By Keck Medical Center of USC At , Los Angeles, 90015, Ca $47.31 - $88.00 an hour
Req 3 years Case management experience in an acute care hospital setting
Assists with denial management to identify opportunities to improve department processes
Demonstrates collaborative working relationships with case managers and payers to ensure authorizations are obtained and current.
Maintains awareness of payer/reimbursement practices and requirements.
Req 3 years Clinical experience.
Req 1 year Experience utilizing InterQual Criteria in CERME format.
Utilization Review Specialist Jobs
By MJ Resource Management At Torrance, CA, United States
Experience with PHP/IOP and SUD.
Experience working with commercial health plans.
Experience w admission and concurrent reviews.
Perform all other duties as assigned Skills:
5 years of Utilization Review.
Ability to create a sense of urgency.
Continuing Care Utilization Review Coordinator Rn (Out Patient Experience Only)
By Kaiser Permanente At , Santa Clara, Ca $71.25 - $92.17 an hour
Longitudinal Medi-Cal Case management working closely with RN's and Social work team.
Must be able to work in a Labor/Management Partnership environment.
Minimum one (1) year of utilization experience required.
Bachelors degree in nursing or health related field required, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
Demonstrated knowledge of diagnostic codes.
Utilization Review (Lvn/Rn), Medical Management - Ft/Days
By MemorialCare Medical Foundation At , Fountain Valley, 92708, Ca $42.68 an hour
Minimum 2 years of utilization / care management experience applying evidence-based criteria.
Experience performing medical management (UM) in electronic referral application preferred.
Utilization Review (LVN/RN), Medical Management - FT/Days
Assures review turnaround times adhere to timeliness standards set by contracting and regulatory requirements and established productivity and quality guidelines.
Implement and maintain systems and processes that meet various regulatory requirements.
Maintain and demonstrate a complete understanding of own scope of practice of licensure and education level.
Utilization Review Specialist Jobs
By Fresno County At , , Ca $88,088 - $107,068 a year
Please click here to view Knowledge, Skills, and Abilities.
Applicants must meet the minimum qualifications and filing requirements for this position by the filing deadline.
TO PREVENT THE DISQUALIFICATION OF YOUR APPLICATION, PLEASE NOTE:
Resumes and attachments are not accepted in lieu of a completed application.
Fresno County Employment Application (must be current, complete, and accurate; amendments will not be allowed after the filing deadline).
Fresno County Department of Behavioral Health
Rn Utilization Review Specialist
By Keck Medical Center of USC At , Los Angeles, 90015, Ca $47.31 - $88.00 an hour

The RN Utilization Management Specialist coordinates communication with admitting financial counselors, case management team, providers, patient financial services, and payers to ensure all services ...

Provider Quality Review Nurse, Rn (Remote)
By Inland Empire Health Plans At , Rancho Cucamonga, 91730, Ca $79,810 - $101,774 a year
Discussing, and reviewing cases with Medical Directors referred to the Quality Management (QM) department.
Significant experience may be considered in lieu of degree:
Effectuate all action items as determined by the Medical Director to resolution of case assignments.
Utilization Review Nurse Jobs
By UCLA Health At , Los Angeles, 90095, Ca

Description Become a key member of a world-class health organization. Contribute to the delivery of Magnet® designated nursing excellence. Take your career to the next level. Ucan do all this and ...

Continuing Care Utilization Review Coordinator Rn
By Kaiser Permanente At , San Leandro, 94577, Ca $71.25 - $92.17 an hour
Must be able to work in a Labor/Management Partnership environment.
Minimum one (1) year of utilization experience required.
Bachelors degree in nursing or health related field required, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
Demonstrated knowledge of diagnostic codes.
Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after hospitalization.
Utilization Review Technician Iii
By Prime Healthcare At Ontario, CA, United States
Bachelor’s degree or four years of relevant experience required.
Knowledge of HIPAA regulations preferred
Completion of a medical terminology course; preferred.
Supervisor - Utilization Management - Rn
By Scripps Health At , San Diego, 92127, Ca $61.58 - $92.39 an hour
One year of Utilization Management RN experience.
Minimum of 2 years experience in case management/utilization review, discharge planning, and Millman/InterQual criteria usage.
BSN, knowledge of health plan benefit coverage and regulations.
Knowledge of managed care operations.
Proficiency in MS Office software, and ability to quickly learn a variety of case management systems.
One year of applicable leadership experience.
Clinical Services Trainer (Rn) - Utilization Management Team - Remote | Wfh
By Get It Recruit - Healthcare At Long Beach, CA, United States

We are currently seeking a highly qualified and experienced RN to join our Clinical Services Training Team. As a member of our team, you will have the opportunity to provide standardized training ...

Care Review Clinician, Pa (Rn) - Remote | Wfh
By Get It Recruit - Healthcare At Long Beach, CA, United States

We are a healthcare services provider that works with members, providers, and multidisciplinary team members to ensure optimum outcomes for patients. We're looking for a caring and dedicated ...