search of a highly motivated candidate to join our talented Team. Job Title: Utilization Review Nurse Location.... Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines. Identifying...
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...
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...
communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization... Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals that meet established...
Job Description Job Summary: Key Job Responsibilities The Utilization Review Case Manager validates the patient... and communication with payers as required. The UR Case Manager follows the UR process as defined in the Utilization Review Plan in...
Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient... either Case Management or Utilization Management. Responsibilities Review patient files and treatment information...
. Primary Responsibilities: This position is for a Clinical Pharmacist working in the Pharmacy Utilization Management team... criteria within the designated service level agreements Evaluate and review all prior authorization requests and render...
for utilization management which includes Concurrent Review (on-site or telephonic Inpatient Care Management). Performs reviews.... Position in this function is responsible for the review and evaluation of specialty injectable information and documentation...
RN Manager of Utilization Management West Los Angeles, California The RN Manager of Utilization Management balances... individually identified patient and family needs with cost effective utilization of resources. The RN Manager of Utilization...
RN Manager of Utilization Management Los Angeles, California The RN Manager of Utilization Management... of care. The RN Manager of Utilization Management expands the Care Management focus. The RN Manager of Utilization Management...
, other regulatory agencies and internal standards and requirements. Provides direction to staff regarding utilization review, care...Manager, Utilization Management Los Angeles, CA, US $165,000 – $175,000 + Bonus + SIGNING BONUS + Paid Relocation...
applications and logs Monitor members/patients followed by Case Management Work directly with a nurse team lead Review pending.... Under the direction of the Utilization Management, Assistant Manager, you will play a key role in processing and managing...
Utilization Review Nurse Remote 2 month contract with probable extension Job Description: Ensuring appropriate..., cost-effective, and high-quality care for New Century Health Plan members Conducting utilization management...
Description As the Appeals & Grievances Nurse, you will play a key role in managing and resolving New Century Health... Plan member appeals and grievances. You will: Ensuring timely, accurate, and thorough review of member and provider...
, such as ambulatory care, home care, or case management. OR experience in Utilization Review or Care Management will be considered in lieu... in a case/care management environment. Preferred: Experience in utilization review, skilled nursing, home health...
with other departments, i.e.: Pre-Admissions, Admissions, Patient Accounts, Utilization Review, PPS Coordinator, etc., to assure positive... / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) Pay...
utilization, cost, efficiency, and appropriateness metrics, as well as clinical outcomes. Tracks outcomes and takes actions... to review outcomes of the programs, address barriers to success, and develop plans for program modifications. Identifies new...
's degree in health-related field, preferred · A Registered Nurse (RN) license or MD diploma (or equivalent) required · Five... or more years of clinical hospital experience; or equivalent of education and experience in case management, utilization management...
. Acts as a liaison between the patient, family, nurse, physicians, multidisciplinary team and patient's healthcare... Nurse (RN) licensure in the state of practice: Required Case management certification: Preferred Essential Functions...
's degree in health-related field, preferred · A Registered Nurse (RN) license or MD diploma (or equivalent) required · Five... or more years of clinical hospital experience; or equivalent of education and experience in case management, utilization management...