Current jobs related to Utilization Management Nurse, Senior - California - Blue Shield of California
-
Senior Partner
2 weeks ago
California, Missouri, United States Wipro Technologies Full timeAbout the RoleWe are seeking a highly experienced Senior Partner to lead our Utilities consulting business unit, focusing on Grid Modernization and Energy Transition. As a key member of our Domain and Consulting (D&C) team, you will be responsible for driving growth, building relationships, and delivering customer value.Key ResponsibilitiesDevelop and...
-
Senior Partner
3 weeks ago
California, Missouri, United States Wipro Technologies Full timeAbout the RoleWe are seeking a highly experienced Senior Partner to lead our Utilities consulting business unit, focusing on Grid Modernization and Energy Transition. As a key member of our Domain and Consulting (D&C) team, you will be responsible for driving growth, building relationships, and delivering customer value.Key ResponsibilitiesDevelop and...
-
Senior HVAC Project Manager
1 month ago
California, United States Gulfstream Strategic Placements Full timeSenior HVAC Project ManagerGulfstream Strategic Placements is seeking an experienced Senior HVAC Project Manager to oversee large-scale commercial HVAC projects in Orange County. This role is ideal for individuals with a proven track record in managing complex mechanical systems, including HVAC, chillers, boilers, and building automation systems.Key...
-
Water Utilities Project Manager
1 month ago
California, United States Fluor Corp Full timeJob Title: Water Utilities Project ManagerFluor and its joint-venture partner AECOM have been awarded a four-year program delivery support services contract for the California High-Speed Rail program by the California High-Speed Rail Authority.The system will connect the 500-mile stretch between the Los Angeles region with the San Francisco Bay Area, with up...
-
FMS Management Analyst Senior
4 weeks ago
California, Maryland, United States Davis Defense Group, Inc. Full timeJob Title: FMS Management Analyst SeniorJob Summary:Davis Defense Group, Inc. is seeking a highly skilled FMS Management Analyst Senior to support the efforts of Case Managers, Program Managers, or Team Leads for various Foreign Military Sales (FMS) programs. The successful candidate will assist in analyzing and managing all aspects of FMS casework in...
-
Acquisition Logistics Manager Senior
2 weeks ago
California, Maryland, United States Sierra Management And Technologies Inc Full timeJob SummarySierra Management and Technologies, Inc. is seeking a highly skilled Acquisition Logistics Manager Senior to join our team. The successful candidate will be responsible for leading the development, operation, evaluation, and improvement of weapon systems supportability or maintainability programs and information systems.This is a challenging and...
-
Senior Project Development Manager
1 month ago
California, United States DSD Renewables Full timeJob Title: Senior Project Development ManagerDistributed Solar Development (DSD) is seeking a highly skilled Senior Project Development Manager to join our team. As a key member of our development team, you will be responsible for driving projects through the development phase, ensuring timely and cost-effective execution.Key Responsibilities:Lead project...
-
Regional Director of Operations
1 week ago
California, United States Agemark Senior Living Full timeAgemark Senior Living: A Leader in Senior CareWe are seeking a highly skilled Regional Director of Operations to oversee the operations of multiple properties within our region. As a key member of our team, you will be responsible for fiscal management, process improvement, staff coaching, facilities management, and compliance with state regulations.Key...
-
Senior Facilities Manager
4 weeks ago
California, Missouri, United States SecureSpace Self Storage Full timeJob Title: Senior Facilities ManagerInSite Property Group is seeking an experienced Senior Facilities Manager to oversee the maintenance and operation of our facilities, ensuring they meet brand standards, are functional, and safe for maximum uptime.Key Responsibilities:Maintain and oversee facilities, including utilities, services, critical...
-
LPN - Licensed Practical Nurse
2 weeks ago
California, United States Discovery Senior Living Full timeAbout the RoleAt Discovery Senior Living, we are seeking a skilled LPN to provide high-quality nursing care to our residents. As a Licensed Practical Nurse, you will play a vital role in ensuring the health and well-being of our seniors.ResponsibilitiesProvide comprehensive nursing care to residents in accordance with their individual plans of care.Conduct...
-
Senior Manager of Power Origination
1 month ago
California, United States Leap29 Full timeSenior Manager of Power OriginationLeap29 is seeking a highly skilled Senior Manager of Power Origination to lead efforts in securing long-term revenue transactions for our U.S. clean energy portfolio. This role will involve sourcing and negotiating contracts with various off-takers and will be a key part of our U.S. leadership team.The successful candidate...
-
Licensed Practical Nurse
1 month ago
California, United States Discovery Senior Living Full timeAbout Discovery Senior LivingAt Discovery Senior Living, we're dedicated to providing exceptional care and services to our residents. As a Licensed Practical Nurse, you'll play a vital role in delivering high-quality nursing care and promoting the well-being of our residents.Responsibilities:Provide comprehensive nursing care to residents, including health...
-
Utility Locator
4 weeks ago
California, United States TEKsystems Full timeDescription: is a dynamic cooperative based in Salisbury, MD. Our mission is to transform Maryland's digital landscape by ensuring accessible and reliable broadband connectivity. We unite businesses, communities, and service providers to advance and strengthen broadband infrastructure throughout the state, aiming to bridge the digital divide, fuel local...
-
Construction Project Manager
2 weeks ago
California, United States Nelson Connects Full timeAbout the Role:We are seeking a highly skilled Project Manager to lead underground utility projects, including water, sewer, and electrical infrastructure. This role involves managing all phases of the project lifecycle to ensure timely delivery, adherence to budget, and compliance with safety and regulatory standards.Key Responsibilities:Develop...
-
Assistant Property Manager
3 weeks ago
California, United States Morlin Asset Management, LP Full timeAssistant Property Manager Job DescriptionWe are seeking a highly skilled and experienced Assistant Property Manager to join our team at Morlin Asset Management, LP. As a key member of our property management team, you will be responsible for supporting the Senior Property Manager in the day-to-day operations of our medical office building.Key...
-
Senior Environmental Planner
4 weeks ago
California, United States Insight Global Full timeJob Title: Senior Environmental PlannerWe are seeking a highly skilled Senior Environmental Planner to join our team at Insight Global. As a key member of our California planning team, you will play a critical role in supporting technical planning guidance and maintaining positive client relationships while managing projects on schedule and within budget.Key...
-
LPN Nurse
3 weeks ago
California, United States Discovery Senior Living Full timeAbout Discovery Senior LivingAt Discovery Senior Living, we're dedicated to providing exceptional care and services to our residents. As a Licensed Practical Nurse (LPN), you'll play a vital role in delivering high-quality nursing care and promoting the well-being of our residents.Responsibilities:Provide comprehensive nursing care to residents, including...
-
Senior Retail Manager
4 weeks ago
California, Missouri, United States Apple Full timeSenior Manager Role at AppleAs a Senior Manager at Apple, you will lead the staff and operations of one or more store areas, driving results that create a high-performing work environment. You will guide other leaders to inspire top performance from their teams, monitor multiple lines of business within the store, and collaborate with corporate business...
-
Contract Nurse RN Utilization Review
3 weeks ago
California, USA, United States Trusted Resource Associates (TRA) Full timeJob Description & RequirementsTrusted Resource Associates (TRA) is seeking a skilled RN Utilization Review professional for a local contract nursing position in California.Specialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Local ContractAs a RN Utilization Review professional, you will be...
-
Registered Nurse
3 days ago
Los Angeles, California, 90071, Los Angeles County, CA, United States CEDARS-SINAI Full timeJob DescriptionJob Summary: Key Job ResponsibilitiesThe Utilization Review Case Manager validates the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria. The UR Case Manager uses medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay...
Utilization Management Nurse, Senior
2 months ago
About the Role
The Utilization Management team at Blue Shield of California reviews inpatient stays for our members and applies nationally recognized levels of care guidelines. As a Utilization Management Nurse, Senior, you will report to the Utilization Management Nurse Manager and be responsible for reviewing clinical information provided by facilities to determine medical necessity for our members' admissions.
Your Key Responsibilities
- Perform prospective, concurrent, and retrospective utilization reviews and first-level determination approvals for members using evidence-based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business, such as Medicare and FEP.
- Conduct clinical reviews of claims for medical necessity, coding accuracy, medical policy compliance, and contract compliance.
- Ensure discharge planning at levels of care appropriate for members' needs and acuity, and determine post-acute needs, including levels of care, durable medical equipment, and post-service needs, to ensure quality and cost-appropriate discharge planning.
- Prepare and present cases to the Medical Director for medical director oversight and necessity determination, and communicate determinations to providers and/or members in compliance with state, federal, and accreditation requirements.
- Develop and review member-centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards, and identify potential quality of care issues, service or treatment delays, and intervene as clinically appropriate.
- Refer to Case Management when there are acute inpatient needs affecting discharge.
- Attend staff meetings, clinical rounds, and weekly huddles.
- Maintain quality and productivity metrics for all casework.
- Buddy or support new employees.
- Maintain a HIPAA-compliant workspace for a telework environment.
