We have other current jobs related to this field that you can find below
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Los Angeles, California, United States MedPOINT Management Full timeJob OverviewPosition: Outpatient Utilization Management Specialist at MedPOINT ManagementRole SummaryThe Outpatient Utilization Management Specialist is essential in enhancing communication between Managed Services Organizations (MSO), Independent Physician Associations (IPA), and members to guarantee seamless member care. Key responsibilities include...
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Los Angeles, California, United States MedPOINT Management Full timeJob OverviewThe Outpatient Utilization Management Coordinator serves as the primary liaison between the Outpatient Utilization Management (UM) team and Health Plan representatives. This position is responsible for managing referral requests directed to Health Plans, including but not limited to tertiary care, durable medical equipment, and pharmacy services,...
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Manager of Utilization Management
4 weeks ago
Los Angeles, United States Pivotal Placement Services, Inc Full timeManager, Utilization Management This is a full-time permanent opportunity with a large hospital system. Ensures cost-effective and quality patient care by appropriate utilization of resources. Provides direction to staff, including Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation, and others as assigned.We are looking for...
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Manager of Utilization Management
4 weeks ago
Los Angeles, United States Pivotal Placement Services, Inc Full timeManager, Utilization Management This is a full-time permanent opportunity with a large hospital system. Ensures cost-effective and quality patient care by appropriate utilization of resources. Provides direction to staff, including Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation, and others as assigned.We are looking for...
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Supervisor, Utilization Management RN
2 weeks 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, we make sure our members get...
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Supervisor, Utilization Management RN
1 month 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
4 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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Utilization Management Supervisor
4 days ago
Los Angeles, California, United States Lincoln Search Consultants Inc Full timeManager, Utilization Management Location: Los Angeles, CA, US Compensation: $165,000 - $175,000 + Bonus + SIGNING BONUS + Paid Relocation *RN Required* On-Call Rotation Required The Manager of Utilization Management oversees the daily functions of the Utilization Management Program within the designated Service Area or Medical Center. This role is pivotal in...
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Utilization Management Nurse Specialist RN II
1 month ago
Los Angeles, United States L.A. Care Health Plan Full timeUtilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11213 Salary 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...
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Manager Utilization Management
2 weeks ago
Los Angeles, United States Kaiser Permanente Full timeJob Summary: Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation and others...
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Manager Utilization Management
3 months ago
Los Angeles, United States Kaiser Permanente Full timeJob Summary: Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation and others...
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Case Manager Utilization RN, 40/hr Day
2 months ago
Los Angeles, United States Kaiser Permanente Full timeSign 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 Nurse Specialist RN II
3 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, we make sure our members get...
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Utilization Management Nurse Specialist RN II
1 month 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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Case Manager Utilization RN, 40/hr Day
4 weeks ago
Los Angeles, United States Kaiser Full timeSign 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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Case Manager Utilization RN, 40/hr Day
2 months ago
Los Angeles, United States Kaiser Full timeSign 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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Case Manager Utilization RN, 24/hr Mid-Shift
4 weeks ago
Los Angeles, United States Kaiser Permanente Full timeSign 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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Case Manager Utilization RN, 24/hr Mid Shift
1 month ago
Los Angeles, United States Kaiser Permanente Full timeJob 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, 40/hr Day
1 day ago
Los Angeles, United States HealthEcareers - Client Full timeSign 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, patient...
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RN - Utilization Mgmt
3 weeks ago
Los Angeles, United States All Medical Personnel Full timeSpecialty: Travel RN-Utilization Management Job Description Consult and coordinate with health care team members to assess, plan, implement and evaluate patient care plans. Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims. Provide direct nursing care to patient and review medical records Prepare...
Utilization Management RN
2 months ago
The Utilization Review Specialist is responsible for the assessment and review of the healthcare delivery system with a concentration on tasks that promote cost-effective quality care and cost containment in accordance with various federal and/or state statutes, regulations and guidelines as well as facility policy.
Essential Duties and Responsibilities:
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Performs utilization review in accordance with all state mandated regulations
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Analyzes insurance, governmental and accrediting standards to determine criteria concerning admissions, treatment, and length of stay
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Assures compliance with state and federal regulations and billing requirements
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Maintains compliance with regulation changes affecting utilization management
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Reviews patient records and evaluates patient progress
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Ensures high standard of patient care by establishing best practice benchmarks
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Obtains and reviews necessary medical reports and related treatment plan to conduct review
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Reviews and validates physician’s orders, reports progress, and unusual occurrences on patients
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Ensures appropriate and cost-effective healthcare services to patients.
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Analyzes patient records and participates in interdisciplinary collaboration with professional staff
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Facilitates educational programs as directed to keep physicians and professional staff informed about regulations affecting utilization management
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Recognizes and reports appropriately cases of fraud, abuse or incorrect utilization
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Consults with Social Services Department regarding the level of nursing care and collaborates with other departments in evaluation of projects affecting discharge plans
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Supports performance improvement programs
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Performs continuing review on medical records and identifies and evaluates need of ongoing hospitalization and services
Minimum Requirements:
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Current license for the state in which the nurse practices if nursing licensure is required by contract
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A Bachelor’s Degree in Nursing or at least two years’ experience in Utilization Review preferred
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Certification in Utilization Review or Utilization Management preferred
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Experience with Microsoft Office Suite and the ability to learn new information systems and software programs
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Strong problem solving, project management and organizational skills with an ability to work in a fast paced environment
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General knowledge of managed care delivery system
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Complies with all relevant professional standards of practice
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Participation and completion of Amergis' Competency program when applicable
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Current CPR if applicable
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TB questionnaire, PPD or chest x-ray if applicable
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Current Health certificate (per contract or state regulation)
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Must meet all federal, state and local requirements
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Successful completion of new hire training as applicable to job site
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Understand patient confidentiality and HIPAA requirements
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Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills; proficiency in the English language is required
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Computer proficiency required
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Must be at least 18 years of age
Benefits
At Amergis, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
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Competitive pay & weekly paychecks
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Health, dental, vision, and life insurance
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401(k) savings plan
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Awards and recognition programs
*Benefit eligibility is dependent on employment status.
About Amergis
Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions.
Amergis is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
