Utilization Management Nurse, Senior
3 weeks ago
Your Role
The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the facilities to determine medical necessity when our members admit. You will also be involved with discharge planning and transfers as needed for higher levels of care or out of network admissions.
Your Work
In this role, you will:
Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and FEP Conducts clinical review of claims for medical necessity, coding accuracy, medical policy compliance and contract compliance Ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity and determine post-acute needs of member including levels of care, durable medical equipment, and post service needs to ensure quality and cost-appropriate DC planning Prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination and communicate determinations to providers and/or members to 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 intervenes or 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 Maintaining HIPAA compliant workspace for telework environment-
Sr Project Manager
1 week ago
Los Angeles, United States Infra-Rec Full timeSenior Project Manager - Utilities We are looking for a Senior Project Manager to join our team of experienced professionals. The ideal candidate will have a strong understanding of the utilities industry and a proven track record of success in managing complex projects. The primary responsibility of the Senior Project Manager will be to oversee the...
-
Senior Utility Coordinator
9 hours ago
Los Angeles, United States HNTB Full timeAt HNTB, you can create a career that is meaningful to you while building communities that matter to all of us. For more than a century, we have been delivering solutions for some of the largest, most complex infrastructure projects across the countr Utility, Coordinator, Senior, Manufacturing
-
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 as...
-
Los Angeles, United States ABBA Project Management Full timeCompany DescriptionABBA Project Management is a global project management firm specializing in complex projects across various sectors, including education, residential, government, public works, and commercial. With a focus on construction, program and project management, and construction consulting support, we provide comprehensive services to our clients....
-
Los Angeles, United States ABBA Project Management Full timeCompany DescriptionABBA Project Management is a global project management firm specializing in complex projects across various sectors, including education, residential, government, public works, and commercial. With a focus on construction, program and project management, and construction consulting support, we provide comprehensive services to our clients....
-
Los Angeles, United States ABBA Project Management Full timeCompany DescriptionABBA Project Management is a global project management firm specializing in complex projects across various sectors, including education, residential, government, public works, and commercial. With a focus on construction, program and project management, and construction consulting support, we provide comprehensive services to our clients....
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $67, Min.) - $87, Mid.) - $107, 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...
-
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...
-
Utilization Management Nurse Specialist RN II
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...
-
Utilization Management Nurse Specialist RN II
1 month 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...
-
Utilization Management Nurse Specialist RN II
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...
-
RN Supervisor, Utilization Management
2 days ago
Los Angeles, United States North American Staffing Group Full timeJob DescriptionJob DescriptionMedica Talent Group is excited to share this Direct Hire opportunity with you!We are looking foran experienced RN Supervisor, Utilization Management seeking a permanent opportunity. Our client offers growth and an exciting workplace to join along with competitive salary rates and great benefits !For immediate consideration,...
-
Senior Property Manager
4 days ago
Los Angeles, United States Countywide Management Full timeJob DescriptionJob DescriptionWho are we?At Countywide Management we understand that providing high-quality property management services is the required foundation for turning a house into a home. Our dedicated team collaborate daily to provide a seamless property management experience, ensuring timely leasing, rent, and maintenance services for our...
-
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...
-
Account Manager
4 weeks ago
Los Angeles, United States NVIDIA Full timeNVIDIA Energy Industry sales team is seeking an account manager to serve our energy and utility organizations. At NVIDIA, we are seeking a high-energy and expert sales professional with a validated successful track record of leading enterprise accounts in oil & gas along with the utility industry. This full-time position requires close working relationships...
-
Case Management
3 days ago
Los Angeles, United States Blue Shield of California Careers Full timeYour RoleThe Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...
-
Tax Director
1 week ago
Los Angeles, United States Food Management Search Full timeWell established and highly profitable regional CPA firm has developed a reputation for excellence and expertise in the accounting and management consulting industry. Providing the services of a large firm with a blended environment of practices, services and industry specializations, we continue to demonstrate renowned industry leadership year-over-year....
-
Tax Director
1 month ago
Los Angeles, United States Management Business Solutions Full timeWell established and highly profitable regional CPA firm has developed a reputation for excellence and expertise in the accounting and management consulting industry. Providing the services of a large firm with a blended environment of practices, services and industry specializations, we continue to demonstrate renowned industry leadership year-over-year....
-
Senior Office Engineer
5 days ago
Los Angeles, United States Yang Management Full timeJob Description Job Description Duties: Coordinates various aspects of project delivery and leads the administration of construction projects including planning, design, budget maintenance, scheduling, labor compliance and completing close-out activities Schedule, document and track project planning and engineering activities with Project Managers,...
-
In Patient Nurse Case Manager
1 month ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob Description MedPOINT ManagementTitle: Inpatient Nurse - Delegated Plans =====================================================================================MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please...
