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Utilization Review Rn Jobs in Los Angeles, 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 ...

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.
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 ...

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 ...

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 ...

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

We’re delighted you’re considering joining us!

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
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.
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.
Utilization Review Coordinator: Rn Or Msw
By The Carolina Center for Behavioral Health At , Greer, 29650
Maintain appropriate records of the Utilization Review Department.
Conducts admission reviews and pre-certs.
Conducts concurrent and extended stay reviews.
Prepares and submits appeals to third party payors.
Participates in activities which enhance professional growth and development.
Demonstrates conduct in keeping with CCBH’s ethical standards.
Utilization Review Rn Jobs
By TidalHealth At Salisbury, MD, United States
Strong analytical, data management and PC skills
Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement
3 or more years of strong clinical experience
Excellent interpersonal communication and negotiation skills
Utilization Review RN Position Requirements
Current and valid license to practice as a RN
Utilization Review Registered Nurse (Rn), Care Coordination, Full Time, Days
By MarinHealth Medical Center At , Greenbrae $66.03 - $99.04 an hour
Basic knowledge of government and private insurance benefits (e.g. Medi-Cal, Medicare, DRGs, and managed care), including reimbursement requirements is needed.
Experience in applying evidence based criteria related to utilization management.
Experience using case management software
National certification in Case Management preferred
Complies with all reporting requirements for mandated, risk management, and other medical/legal situations consistent with confidentiality policies and department standards.
Must be assertive and creative in problem solving, system planning and management.
Medicaid Utilization Review Analyst
By State of Idaho At , Coeur D'alene $26 an hour
(PERSI) that offers a lifetime benefit.
Excellent medical, dental and vision insurance- (full-time) employee only coverage for PPO $65/month for medical and vision & $11.00/month for dental
Generous vacation and sick leave accrual beginning as soon as you start
11 paid holidays a year
Multiple savings plans, optional 401K, and optional 457
An opportunity for student loan forgiveness
Behavioral Health, Utilization Management Review, Lcmhc/Lcsw/ Rn
By AmeriHealth Caritas At , Greensboro
Two or more years of behavioral health experience.
Strong problem solving skills and decision making skills.
This position requires residency in the state of North Carolina.
Current active professional licensure required in North Carolina: LCMHC, LCSW, RN
Proficiency in Microsoft Office, including Word, Excel and Outlook is required.
Ability to communicate in a positive/professional manner both orally and written.
Utilization Review Representative Jobs
By Ethos At Dallas, TX, United States
Receives, screens and manages mail, faxes and calls.
Collection and data entry of structured clinical data (including diagnosis, diagnosis codes, procedures, procedure codes).
Reviews service request for completeness of information.
Assigns reviews to Utilization Review Nurse
Assists with written determination letter communications via fax, e-mail or written mail under.
Maintains confidentiality and security in all aspects of performance.
Utilization Review Rn (Austin, Texas)
By Ascension At , Remote From $69,555 a year
Provide case management and/or consultation for complex cases.
Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
Schedule: Full-Time, 8-hour day shift, Monday - Friday, Fully Remote
Facility: Automated Benefit Services (ABS)
Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
Knowledge of Government Insurance Prgram plans.
Social Worker Msw - Utilization Review
By Providence At , Napa, 94581
1 year experience as a Social Worker or Counselor.
Check out our benefits page for more information about our Benefits and Rewards.
Master's Degree in Social Work or Counseling Psychology.
Rn Specialist Utilization Review
By HonorHealth At , Scottsdale, 85258
Determines qualifications for hospital level of care based on set criteria.
Initiates chart reviews, conducts follow-up reviews, and escalates secondary reviews to Physician Advisor as necessary.
Performs other duties as assigned.
Rn Utilization Management Jobs
By Carewise Health, Inc At , Remote
A minimum of three years utilization management experience working with individuals with complex care needs experience preferred.
Organization and time management skills are essential.
Utilizes nursing experience and judgment in addition to the client specific guidelines when determining medical necessity and quality check dates.
A minimum of three years clinical nursing experience preferred.
Intermediate level skills in Microsoft applications (Excel, Word, Outlook, and Windows environment).
Excellent verbal and written communication skills.
Case Manager Utilization Rn
By Kaiser Permanente At , Baldwin Park $58.43 - $71.51 an hour
Two (2) years combined RN experience in an acute care setting or case management required.
Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management.
Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
Prn-Ur Clinical Review Rn - Support Center (Remote)
By Children's Healthcare of Atlanta At , Brookhaven, 30329

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Utilization Review Director Jobs
By Coastal Behavioral Health At , Savannah, 31406
Challenging and rewarding work environment
Excellent Medical, Dental, Vision and Prescription Drug Plan
401(K) with company match and discounted stock plan
Career development opportunities within UHS and its 300+ Subsidiaries