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The RN Utilization Management (RN UM) functions as a support liaison for a variety of UM functions which may include the e‑TAR process, denials management, and the UM process. Coordinates care submission relating to the process of health care...

Care Career is seeking a travel nurse RN Case Management for a travel nursing job in Santa Monica, California. Job Description & Requirements Specialty: Case Management Discipline: RN Start...

GQR Healthcare is seeking a travel nurse RN Case Management for a travel nursing job in Burbank, California. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date:...

Description Position at Healthmap Solutions Company Background Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise...

OverviewHospitals on Incredible Health are actively hiring and accepting applications in the Los Angeles, CA area for the position: Registered Nurse - House Supervisor. Nurses with experience in any of the following areas are strongly encouraged...

Position Description Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and...

Medical Review RN IV – Commercial Appeals & Grievance Nurse Location: Remote – Candidate Must Reside in California Duration: 6+ Months Contract-to-Hire Schedule: Monday-Friday | 9:00 AM – 5:00 PM Pay Range:...

Your Role The Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support...

Hours: FT, Mon-Fri 8:30-5p Under the direction of the Care Management Manager, the Health Coach functions as the primary nurse to provide both health coaching and case management services to members across the continuum of...

JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing and providing date for regulatory...

Overview The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in...

Registered Nurse - Primary Care Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health...

Job Description EF ACADEMY is a private international boarding school in Pasadena, CA. We seek a part-time compassionate and empathetic Registered Nurse (RN) to join our Nursing Team in the Health Center which...

Pathways Critical Incidents Nurse UnitedHealth Group is a health care and well-being company that's dedicated to improving the health outcomes of millions around the world. Here, your contributions matter as they will help transform...

A prestigious health institution in Santa Monica, California, is seeking an experienced Nurse to assess and coordinate care for patients. This role involves developing individualized care plans, performing utilization reviews, and collaborating...

Case Management Nurse, Senior The Children's Services Program (CSP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Case...

AltaMed Health Services Corp in Montebello, California, seeks a qualified RN Case Manager to coordinate care for patients with chronic diseases. This role involves collaboration with an interdisciplinary team to manage cases and ensure...

Care Navigator Position Position at Healthmap Solutions Company Background Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations.

To support a growing team, the full-time remote Registered Nurse Bill Review will review facility and professional bills for accuracy, negotiate pre-surgical services, and provide expertise to claims staff while ensuring compliance with managed...

It's a great feeling to work for a company that does so much good for others around the world! Education Req: Bachelor's degree required. Bachelor's or Master's degree in Behavioral Sciences, Human Services, or Social Services...

Job SummaryWorks collaboratively with an assigned panel of physicians to manage the patient's specialized needs. The managing team differs according to the chronic disease. Duties include assessment to identify member needs and the development of...

Job Summary: The Utilization Management Policy Initiatives Nurse RN II, under the purview the Utilization Management (UM) Department Leadership Team, is responsible for managing, reviewing, updating and creating...

Summary We are currently hiring for an RN Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as an RN Case Management Coordinator, care management interventions focus on improving care...

RN Infection Prevention Responsible for management of Infection Prevention and Control (IPC) activities under the guidance of the Manager of Infection Prevention. Provides coordination and support for the implementation of a system-wide...

Prior Authorizations, Case Manager (LVN/RN)#UHM-5092West Hills, California, United StatesWork Model On-SiteJob Description Position Summary:The role of the Prior Authorization Review Nurse, LVN/RN is to promote the quality and cost effectiveness...