Nurse Utilization Manager
3 days ago
We are seeking a highly skilled and experienced Registered Nurse to join our Utilization Management team at PIH Health. As a Utilization Management RN, you will play a critical role in ensuring that patients receive the most appropriate level of care, while also promoting efficient and effective use of healthcare resources.
Key Responsibilities- Perform utilization review activities, including precertification, to ensure that patients receive the most appropriate level of care.
- Conduct initial reviews, concurrent reviews, and retrospective reviews to determine medical necessity and ensure compliance with guidelines.
- Collaborate with a multi-disciplinary team to manage patient care and promote efficient use of healthcare resources.
- Prepare cases for Physician Advisor review and delegate tasks to LVNs as needed.
- Develop and implement effective case management plans to ensure timely and appropriate levels of care for patients.
- Current licensure as an RN in the state of California.
- A minimum of 2 years of bedside nursing experience in an acute care setting.
- A minimum of 2 years of case management experience.
- Knowledge of payer requirements and Milliman Care Guidelines (MCG).
- Preferred: Certified Case Manager or Accredited Case Manager, BSN, and experience with electronic systems.
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County, and San Gabriel Valley region. We are committed to providing high-quality patient care and promoting a culture of excellence and innovation.
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Estimator - Earthwork and Underground Utilities
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Pasadena, Texas, United States HCA Houston Healthcare Southeast Full timeAbout the RoleWe are seeking a highly skilled Registered Nurse Manager to join our team at HCA Houston Healthcare Southeast. As a Registered Nurse Manager, you will play a critical role in ensuring the delivery of high-quality patient care and leading our nursing team to achieve exceptional outcomes.Key ResponsibilitiesAssist the Director in coordinating...
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Nurse Manager
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Nurse Manager Medical Surgical
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Health Solutions Case Manager II
2 days ago
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Nurse Manager Medical Surgical
3 days ago
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Mental Health Nurse Specialist
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Nurse Manager Medical Surgical
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Registered Nurse Manager Position
1 week ago
Pasadena, Texas, United States HCA Houston Healthcare Southeast Full timeJob SummaryWe are seeking a Registered Nurse Manager to join our team at HCA Houston Healthcare Southeast. As a Registered Nurse Manager, you will be responsible for assisting the Director with department activities, coordinating Performance Improvement activities, and ensuring that nursing care is based on the nursing process.ResponsibilitiesAssist the...
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Mental Health Nurse Specialist
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Nurse Manager
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