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
AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare FoundationDoes the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?If so, AIDS Healthcare Foundation is the place for youFounded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.AHF’s core values are:• Patient-Centered• Value Employees• Respect for Diversity• Nimble• Fight for What’s Right STILL INTERESTED? Please continue
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YOUR CONTRIBUTION TO OUR SUCCESSThe Utilization Management Nurse blends the mission of AHF with strong nursing skills to navigate our HIV/AIDS specialty health plan members through acute care transitions. With a caring and knowledgeable focus, you will collaborate with the RN Care Team Managers (RNCTMs), Medical Director, and Department Management to facilitate timely utilization review of all acute and skilled nursing facility admissions, discharges and continued stays. As part of this role you will engage directly with hospital and SNF case management and utilization staff to obtain clinical records, updates and assist with safe discharge planning. Your participation will include monitoring adherence to treatment plans for the acute/skilled stay and communicating effectively to the RNCTM any member concerns or changes in health condition requiring additional care planning and interventions. You may also be called upon to join the RNCTM and/or Medical Director to visit a member at a facility to clarify any discharge needs for highly complex transitions.
By utilizing core principles of nursing, you will meet our members where they are, identify strengths and opportunities for growth and assist them with realistic goal setting and discharge planning. As a core member of the department you will work with our interdisciplinary team to educate, reinforce, rehabilitate, and support our members to heal and grow and to potentiate their health status and improve their quality of life. You will lead daily Utilization Review rounds soliciting feedback from the Medical Director, RNCTM, Social Worker and Management to contribute to the divisions review for medical necessity, under and over utilization and as a result improve our member’s quality health outcomes.
As the UM/UR Nurse you will help facilitate the shift between levels of care and be aware of social determinants that contribute to admissions and potentiate any barriers for successful discharge planning. You will work to complete portions of the transition assessment in conjunction with the RNCTM including authorization, preadmission planning and education for approved elective transitions, coordination of follow-up post-acute visits with Primary and Specialty Care Providers, provision of durable medical equipment, coordination of home health and IV Therapy services and when applicable linkage to In Home Supportive Services to further support successful transitions to home.
AHF CommitmentWe at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment.AHF will consider qualified applicants with criminal histories in a manner consistent with the requirements of the ordinance.
