Manager of Utilization Management, RN
Found in: Talent US A C2 - 2 weeks ago
Essential Responsibilities: Assists in developing and maintaining policies and procedures for the Service Area or Medical Center related to Utilization Management. Collaborates with the multi-disciplinary teams to plan and coordinate care across the continuum. Coordinates and manages members' care with non-KFH hospital facilities and providers. Identifies risk management and quality of care issues across the continuum. Surfaces issues and any suggestions to the appropriate multi-disciplinary team members. Manages transportation program to ensure appropriate utilization of resources which meet Health Plan guidelines and patient needs. Assures compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements. Provides direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care. Assists in conducting statistical studies in utilization trends, patterns, and outcomes. Hires, trains coaches, disciplines professional and clerical support staff.
Basic Qualifications:Experience Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting to also include supervisory or management experience.Education BSN or bachelor's degree in healthcare related field such as management, health services administration.License, Certification, Registration Current California RN license.
Additional Requirements: Demonstrated knowledge of operations and healthcare management; TJC, Title XXII, Medicare, MediCal and other local, state and federal regulations. Knowledge of managed care operations. Demonstrated interpersonal, negotiation, and management skills. Good oral and written communication skills. Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications: N/A.
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Supervisor, Utilization Management RN
Found in: beBee jobs US - 1 week ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $102, Min.) - $132, Mid.) - $163, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
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Supervisor, Utilization Management RN
Found in: beBee S US - 2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2...
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Supervisor, Utilization Management RN
5 hours ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five...
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Case Manager Utilization Rn-per Diem
7 days ago
Los Angeles, United States Kaiser Permanente Full time**Job Summary**: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a...
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Case Manager Utilization RN-Per Diem Night
Found in: Talent US C2 - 2 days ago
Los Angeles, United States Kaiser Permanente Full timeDescription: Job Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to...
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Utilization Management Nurse Specialist RN II
Found in: beBee S US - 2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
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Utilization Management Nurse Specialist RN II
Found in: beBee jobs US - 2 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $88, Min.) - $115, Mid.) - $142, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
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Case Manager Utilization Rn, 40/hr Day
3 days ago
Los Angeles, United States Kaiser Permanente Full time**Sign On Bonus for Eligible External Hires** **Job Summary**: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family,...
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Utilization Management Admissions Liaison RN II
Found in: beBee S US - 2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
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Utilization Management Admissions Liaison RN II
Found in: beBee jobs US - 2 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $88, Min.) - $115, Mid.) - $142, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
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Case Manager Utilization RN, 24/hr Mid-Shift
Found in: Talent US C2 - 2 weeks ago
Los Angeles, United States Kaiser Permanente Full timeDescription: Job Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to...
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RN Case Manager
Found in: beBee jobs US - 2 weeks ago
Los Angeles, California, United States Prospect Medical Holdings, Inc. Full timeThe RN Case Manager is responsible for performing clinical assessment and reassessment of acute care Inpatients for the purpose of performing utilization review, resource management and safe discharge planning. The RN Case Manager prioritizes, plans, organizes, and implements timeliness of care. Collaborates with the interdisciplinary healthcare team to...
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Investments Manager
1 day ago
Los Angeles, United States Iconic Manager LLC Full time**Summary**: The Manager, Investments will play a pivotal part in the end-to-end investment process from initial due diligence through deal close. As a Manager you will collaborate with team members across the organization to support the execution and evaluation of strategic investment opportunities. **Responsibilities**: - Evaluate acquisition...
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Web Inquiry Support Coordinator
1 week ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob DescriptionSummaryThe Web Inquiry Support Coordinator provides effective web communication between MSO, IPA providers, health plan representatives to coordinate member care. Communication to include accessibility to care, validating contract, modification request and ensuring timeliness standards are met. The Web Inquiry Support...
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Utilization Management/Appeals and Grievances Nurse Specialist RN II
Found in: beBee S US - 2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members...
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Utilization Management/Appeals and Grievances Nurse Specialist RN II
Found in: beBee jobs US - 1 week ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $88, Min.) - $115, Mid.) - $142, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
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Utilization Management Nurse Specialist LVN II
Found in: beBee S US - 2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
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SUPERVISOR, UTILIZATION MANAGEMENT RN
Found in: Careerbuilder One Red US C2 - 3 days ago
Los Angeles AFB, CA 90009, USA, United States L.A. Care Health Plan Full timeSalary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five...
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Utilization Management/Appeals and Grievances Nurse Specialist RN II
Found in: beBee S US - 2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
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Local Contract Nurse RN
7 days ago
Los Angeles, United States Pyramid Consulting Full timePyramid Consulting is seeking a local contract nurse RN Utilization Review for a local contract nursing job in Los Angeles, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: 05/06/2024Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Local ContractPerks: Employee benefits include, but are...
