Description As the Utilization Management & Quality Review Nurse, you will be responsible for: Ensuring appropriate..., cost-effective, and high-quality care for New Century Health Plan members Conducting utilization management...
This is a remote position. We are seeking a Registered Nurse with clinical experience to join our Utilization... Management team. In this role, you will utilize your clinical skills in collaboration with other healthcare professionals...
Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient... in either Case Management or Utilization Management. Responsibilities Review patient files and treatment information...
Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals that meet established... Required: At least 5 years of varied clinical experience in an acute hospital setting. At least 2 years of Utilization Management/Case...
and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management... with Optum Medical Directors on performing utilization management Participation in discussions with the Clinical Services team...
. We are in search of a highly motivated candidate to join our talented Team. Job Title: Utilization Review Nurse Location... members. Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines...
coordination of member care with internal L.A. Care departments such as Care Management (CM), Utilization Management (UM), Managed... in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The...
communities and residents and to support the safety net required to achieve that purpose. Job Summary The Care Management... Specialist II utilizes clinical skills and training to perform essential functions of care management for identified and assigned...
: Registered Nurse (RN) licensure in the state of practice: Required Clinical Nurse Specialist (CNS) in the state of practice..., evaluation and management of surgery patients. Performs routine follow-up care after review of patient care needs, determining...
experience preferred in managed care setting, preferably in utilization or case management in ambulatory or inpatient setting... Nurse (RN) Case Manager/Care Coordination Team Leader has the responsibility to case manage all PACE participants who...
setting. Works with Inpatient Case Management and Inpatient Nursing to support and coordinate hospital discharge... to outpatient services provided through the value-based program such as Ambulatory Care Management. Follows and coordinates care...
leadership working collaboratively with the Nurse Manager, Director, Physicians, and staff. Supervises and directs the activities...: Preferred Supervisory experience or demonstrated supervisory skills: Required Licenses/Certifications: Registered Nurse...
City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed Clinical Social Worker...-effective care within the allotted time frame; assuring payments of hospital-based services meeting patient-related utilization...
setting is highly desired Experience in handling appeals, grievances, utilization management, or potential quality issues...Description As the Appeals & Grievances Nurse, you will play a key role in managing and resolving New Century Health...
Job Summary: The Clinical Nurse Specialist role at Kaiser Permanente Southern California Region is a clinical manager... providers. Participates as a part of management in providing 24 hour clinical leadership by developing standards of practice...
Job Summary: The Clinical Nurse Specialist role at Kaiser Permanente Southern California Region is a clinical manager... providers. Participates as a part of management in providing 24 hour clinical leadership by developing standards of practice...
experience preferred in managed care setting, preferably in utilization or case management in ambulatory or inpatient setting... Nurse (RN) Case Manager/Care Coordination Team Leader has the responsibility to case manage all PACE participants who...
Job Summary: The Clinical Nurse Specialist role at Kaiser Permanente Southern California Region is a clinical manager... providers. Participates as a part of management in providing 24 hour clinical leadership by developing standards of practice...
with advanced level pediatric clinical experience and utilization management and/or discharge planning experience. Thorough... knowledge of managed care, utilization management, discharges planning, and continuous quality improvement concepts. Computer...
leadership working collaboratively with the Nurse Manager, Director, Physicians, and staff. Supervises and directs the activities...: Preferred Supervisory experience or demonstrated supervisory skills: Required Licenses/Certifications: Registered Nurse...