Utilization review nurse jobs in Buena Park, CA - 262 jobs

D'Leon Consulting Engineers is seeking a Third Party Utility Coordinator in Los Angeles, California Responsibilities Conduct detailed utility investigations to identify existing infrastructure, assess potential conflicts, and recommend solutions during project planning and execution phases. Coordinate with utility providers, contractors, and project teams to ensure timely relocation, installation, and integration of utility services. Review and interpret construction plans, scopes of work (SOW), and project schedules to identify utility impacts and requirements. Obtain necessary permits, approvals, and agreements from utility companies and regulatory agencies to ensure project compliance. Develop and maintain utility coordination documentation, including utility adjustment plans, easement agreements, and status reports. Organize and facilitate utility coordination meetings to align stakeholders on project timelines, requirements, and resolutions. Monitor utility relocation and installation progress, ensuring work aligns with project schedules, safety standards, and quality expectations. Provide technical guidance on design adjustments, cost estimates, and risk mitigation strategies related to utility coordination. Resolve utility conflicts by collaborating with engineers, contractors, and utility providers, ensuring minimal disruptions to the project timeline. Stay updated on local, state, and federal regulations regarding utility coordination and infrastructure projects. Qualifications Bachelor's degree in Civil Engineering, Construction Management, or a related field (or equivalent experience). Proven experience in utility coordination, utility relocation, or construction project management. Strong knowledge of utility systems, infrastructure design, and regulatory requirements. Proficiency in AutoCAD, GIS software, and project management tools. Excellent problem-solving, organizational, and time management skills. Exceptional verbal and written communication skills, with the ability to collaborate effectively with diverse stakeholders. Ability to manage multiple projects simultaneously and adapt to changing priorities. Familiarity with construction safety standards and practices.

Labor and Delivery travel nurse job in Los Angeles, CA - earn $2,925/week on a 13 week, Nights shift at a travel-friendly hospital with Advantis Medical. Looking for Labor and Delivery travel nursing jobs near you? This contract follows a (3×12) schedule and offers high pay, clinical experience, and the full support of the #1 rated travel nurse agency. Whether you're planning your next assignment in California or searching for "Labor and Delivery travel RN jobs near me", this opportunity could be the perfect fit. This travel assignment is perfect for nurses looking to be near Los Angeles, CA. Don't miss out-click "I'm Interested" to start your application and connect with an Advantis recruiter to explore more travel Labor and Delivery nurse jobs near you. Job Details Facility: Hollywood Presbyterian Location: Los Angeles, CA 90027 Explore the area! See our local guide and an interactive map further down this page. Contract Length: 13 Weeks Shift: Nights (3×12) Travel Nursing Requirements: 2+ years of recent Labor and Delivery nursing experience. Active California RN License or Compact License (if applicable) Benefits Day One Benefits - Medical, Dental, Vision & 401(k) Relocation and Travel Reimbursement Dedicated team to help with travel & housing accommodations Weekly Direct Deposit $500 Referral Bonuses Near Los Angeles, CA Los Angeles, CA is one of the nation's busiest healthcare hubs, where assignments stretch across a wide metro and diverse patient populations. Off the clock, hike through Griffith Park to its observatory for sweeping city views, or unwind at the Santa Monica Pier. The city's coastline and museum districts provide countless ways to recharge between shifts. For clinicians pursuing travel RN jobs near me, opportunities remain steady in hospitals and specialty centers throughout the region. Travel Nursing jobs also extend into nearby Pasadena, Long Beach, and Burbank. Blending cultural variety with consistent professional demand, Los Angeles, California offers healthcare travelers a setting as dynamic as the city itself. FAQs - Labor and Delivery Travel Nurse Jobs Near Los Angeles, CA Expand All Are there Labor and Delivery travel nursing jobs near Los Angeles, California? Yes! Advantis Medical frequently staffs Labor and Delivery travel RN jobs in Los Angeles and nearby areas like Long Beach (90802), Anaheim (92805) and Pasadena (91101). This assignment offers $2,925 per week and is one of our top current opportunities. Is Los Angeles a good location for Labor and Delivery travel nursing jobs? Yes. With competitive pay, career-boosting clinical environments, and great local lifestyle perks, Los Angeles is a top destination for Labor and Delivery travel nurse jobs in California. What certifications are required for this L&D travel nurse job? Most L&D nurse jobs will require Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), and Neonatal Resuscitation Program (NRP) certifications. For high-risk OB roles, certifications like AWHONN Fetal Heart Monitoring are often preferred. Click "I'm Interested" to connect with a recruiter who can walk you through exactly what's needed for this role. Can I work as a travel nurse in California with a compact nursing license? California Board of Nursing Contact information Website: https://www.rn.ca.gov/ Phone: 916.322.3350 Fees License by Exam: $150 (+$200 exam fee) License by Endorsement: $150 Fingerprinting: $49 Temporary License: $50 Timing Processing Time: 3 - 6 months Valid for: 2 years Renewal Schedule: every 2 years, by your birthday General Information Nurse Licensure Compact: No Nursys: Yes CEU Requirements: CEU Requirements: 30 hours Helpful Links Apply Now Check Status Verify License License Renewal Travel Nursing Jobs With Advantis Medical - The Gold Standard At Advantis Medical Staffing, we take great pride in our commitment to caring for travel nurses. We are dedicated to connecting nurses with the best travel nursing jobs nationwide, while providing exceptional service that fosters a trusted partnership for life. Our mission is to deliver the "Gold Standard" in service -not only by securing your first assignment but by advocating for your long-term career goals and well-being. Experience our gold standard level of service as we create a stress-free and rewarding journey for you. View Similar L&D Jobs ⟶ Travel Nursing Job in Los Angeles, CA Weekly Pay: $2,925 This pay combines taxable wages and tax-free stipends. For a full, transparent breakdown, submit the "I'm Interested" form, & a recruiter will send you the details. × Location: Los Angeles, CA 90027 Explore the area! See our local guide and an interactive map further down this page. × Facility: Hollywood Presbyterian Specialty: Labor and Delivery Duration: 13 weeks Shift: Nights (3x12) I'm Interested Have a question? Call us at 214-305-6445

Provides professional nursing direct patient care in compliance with professional practice and unit standards. Promotes a collaborative, interdisciplinary approach towards patients, families and all members of the care delivery team. ESSENTIAL FUNCTIONS Assess, plan, implement, and evaluate patient care needs. Documents patient care in the healthcare record according to established standards. Directs and delegates care to other team members in accordance with their education, credentials, and demonstrated competence. Ensures own professional effectiveness through education and professional development. Participates in the development of and maintains established hospital policies, procedures and objectives, quality improvement, safety, environmental and infection prevention program. Performs other duties as assigned. QUALIFICATIONS EDUCATION: Graduate of an approved school of nursing required. BSN or current enrollment in a BSN program preferred. Specialty certification preferred. EXPERIENCE/TRAINING: Two years of recent RN acute care experience required within last 5 years Six months experience in inpatient or outpatient behavioral health/psychiatry/community based mental health settings preferred. Demonstrated knowledge of and ability to apply age specific principles of growth and development and life stages to meet each patient's needs. LICENSE/CERTIFICATION: Current Registered Nurse licensure in the state in which nurse will be practicing. Current BLS (Basic Life Support) certification required at date of hire. ACLS certification preferred. Qualifications Additional Information All your information will be kept confidential according to EEO guidelines. (iNT)

Aztec Healthcare - We're offering excellent compensation for qualified nurses to work either temporarily or long-term for our skilled nursing home in Aztec, New Mexico! Start Date: ASAP Duration: 13 weeks (possible renewal) Shift: 12 hours. Payrate: $45.00 / HR LVN $50.00 / HR RN Job type: Travel (Full-time) Location: Aztec, New Mexico Aztec Healthcare is a FANTASTIC Long-Term Care Facility. We are looking for FANTASTIC people like YOU to join our TEAM! What does success in Long-Term Care look like? YOU! Come Join our Team of Successful Caregivers! If you have what it takes to care for our individuals. Join our Aztec Healthcare Team! We are like a family and our employees have been here for ages! We serve our Residents daily with a Spirit of Excellence! Don't be a stranger and come apply today! Benefits: (Contract Employees are exempt). 401(k) Dental insurance Health insurance Life insurance Vision insurance If you are compassionate and love to take care of people, then we invite you to consider us as your new employer. We are needing Charge Nurses for 12 hour shifts! We are offering competitive wages and we welcome multi state licensees! New graduates are welcome and will be trained! Your Responsibilities • Ensures delivery of high-quality, positive clinical outcomes, and resident/family satisfaction during supervisory shift. • Serves as a resource to all staff within the facility regarding the quality of services provided. • Provide direct resident care when required; Demonstrates the ability to administer medications and treatment timely and according to facility policy; Demonstrates ability to receive, transcribe, and carry out physician orders, if allowed by Nurse Practice Act. • Effectively manages nursing personnel on shift to limit use of overtime and agency personnel. • Assesses the work performance of nursing staff as it relates to unit standards of care and goals. • Conducts regular staff meetings on each shift and provides updates to DON. Your Qualifications • Graduate of an approved Licensed Vocational program and licensed in the state of practice, required. • Minimum of 2 years of nursing experience in a Skilled Nursing Facility preferred. • Current BLS/CPR certification (All SNFs; ALFs as required by state). Aztec Healthcare provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Prime Staffing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Orange, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours Employment Type: Travel About the Position Specialty: RN - Utilization Review Experience: 2+ years of experience in utilization review, case management, or acute care nursing License: Active State or Compact RN License Certifications: BLS - AHA; Certified Case Manager (CCM) preferred Must-Have: Strong understanding of insurance guidelines, medical necessity criteria (e.g., InterQual or MCG), and discharge planning Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays. The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs. Requirements Required for Onboarding: Active RN License BLS Prime Staffing Job ID #35663858. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:Utilization Review,08:00:00-16:00:00 About Prime Staffing At Prime Staffing, we understand the importance of finding the perfect fit for both our clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing the most qualified contingent staffing to our clients, and the most competitive contracts to our workforce. Our experienced team takes the time to get to know both our clients and candidates, their needs, and preferences, to ensure that each placement is a success. We offer a wide range of staffing services including temporary, temp-to-perm, and direct hire placements. Our extensive network of qualified candidates includes nurses, allied healthcare professionals, corporate support professionals and executives.

Benefits: 401(k) Competitive salary Dental insurance Health insurance Paid time off Signing bonus Training & development Vision insurance Outpatient Case Management West Los Angeles VAMC 11301 Wilshire Blvd Los Angeles, CA. 90073 There are five new RN vacancies at the West Los Angeles VA Medical Center. Service Line | Unit | Position Title | Tour | Qualified Contractor | Vendor HOSPITAL OPERATIONS | INPATIENT | RN | 0630-1500 | Vacant | Open HOSPITAL OPERATIONS | INPATIENT | RN | 0630-1500 | Vacant | Open HOSPITAL OPERATIONS | INPATIENT | RN | 0630-1500 | Vacant | Open HOSPITAL OPERATIONS | OUTPATIENT | RN | 0730-1600 | Vacant | Open HOSPITAL OPERATIONS | OUTPATIENT | RN | 0730-1600 | Vacant | Open Benefits/Perks Competitive Compensation Great Work Environment Career Advancement Opportunities Job SummaryWe are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we are running at optimal efficiency, and that all patients under our care are receiving the necessary treatments and procedures. The ideal candidate has deep experience in a similar medical setting, has a bachelor's or higher in Nursing, and has a certification in either Case Management or Utilization Management. Responsibilities Review patient files and treatment information for efficiency Monitor the activity of staff to ensure effective patient treatment Advocate for quality patient care to prevent complications Review discharge information for outgoing patients Work closely with clinical staff to provide excellent patient care Prepare reports on patient management and cost assessments Dimensions of Nursing Practice PRACTICE: Knowledge of professional nursing practice and the ability to apply the nursing process (assessment, diagnosis, outcome identification, planning, implementation, and evaluation) with close supervision.Expectations:1. Completes orientation according to expected standards. 2. Works with close supervision, is responsible and accountable for individual nursing practice and seeks direction from others as needed. 3. Manages workload as assigned, organizes, and completes own assignments in an efficient and appropriate manner. 4. Participates in the development, implementation, and evaluation of interdisciplinary care.5. For Inpatient RNs, performs unit based inpatient case management duties, with the ability to perform RN case management assessments, discharge planning, formulating safe plans of care and anticipating patient care needs. VETERAN/PATIENT DRIVEN CARE: Knowledge of Veteran/patient driven care, patient experience, satisfaction, and safety.Expectations:1. Establishes a therapeutic relationship, allowing the patient to attain, maintain or regain optimal function through assessment and treatment. 2. Engages patients, families, and other caregivers to incorporate knowledge, values, and beliefs into care planning without judgement or discrimination. 3. Knowledgeable of ethical issues related to professional nursing practice and follow established policies of the practice setting, VA, and ANA Code of Ethics for Nurses. 4. Aware of high reliability principles to deliver consistent care and improve patient outcomes. LEADERSHIP: Communicates, collaborates, and utilizes leadership principles to perform as an effective member of the interprofessional team.Expectations:1. Demonstrates positive, effective communication skills and professional behaviors that promote cooperation and teamwork with internal and external customers. PROFESSIONAL DEVELOPMENT: Incorporates educational resources/opportunities and self-evaluation for professional growth.Expectations:1. Participates in unit based educational activities and continuing education requirements. 2. Responsible for maintaining competency to continue personal and professional growth. EVIDENCE-BASED PRACTICE/RESEARCH: Awareness of evidence-based practice/research to improve quality of care and resource utilization.Expectations:1. Applies evidence-based practice/research to patient care. 2. Participates in unit-based activities to improve and deliver cost effective patient care. 3. Demonstrates knowledge of specific unit level performance improvement activities. 4. Incorporates patient preferences into shared care delivery decisions. Customer Services Requirements: The incumbent meets the needs of the Veteran and as appropriate the Veteran's family, caregiver and/or significant other, the Veteran's representative, visitors to VA facilities, all VA staff and other customers while supporting VA missions. The incumbent consistently communicates and treats the Veteran and as appropriate the Veteran's family, caregiver and/or significant other, the Veteran representatives, visitors to VA facilities, all VA staff, and other customers in a courteous, tactful, and respectful manner. The incumbent provides the Veteran's family, caregiver and/or significant other, the Veteran's representative, visitors to VA facilities, all VA staff, and other customers with consistent information according to establish policies and procedures. The incumbent handles conflict and problems in dealing with any consumer group appropriately and in a constructive manner. Age, Development, and Cultural Needs of Patients Requirement: The primary age of Veterans treated is in their middle years (ages 40 to 50) or at the geriatric level (ages 60 or older). There are occasionally younger patients between the ages of 25 to 40 years of age that require care. The position requires the incumbent to possess or develop an understanding of the particular needs of these types of patients. Sensitivity to the special needs of all patients in respect to age, developmental requirements, and culturally related factors must be consistently achieved. Computer Security Requirement: The incumbent protects printed and electronic files containing sensitive data in accordance with the provisions of the Privacy Act of 1974 and other applicable laws, Federal regulations, VA statutes and policy, and VHA policy. The incumbent protects the data from unauthorized release or from loss, alteration, or unauthorized deletion. Follows applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in the computer access agreement that the incumbent signs. Reports all known information security incidents or violations to the supervisor and/or the Information Security Officer immediately. Reports all known privacy incidents or violations to the Privacy Officer immediately. Compliance is measured by supervisory observation and periodic random monitoring by the Information Security Officer or Office of Information Technology staff. Major violations such as loss of or unauthorized release, alteration, or deletion of sensitive data are unacceptable. Other Significant Information: This position potentially requires flexibility in schedule and assignments. For RN Inpatient Case Management staff, there may be rotation to 0830-1700 from the initial 0630-1500 (Monday - Friday) Qualifications: BSN and/or MSN preferred. Minimum of 5 years of successful nursing practice, encompassing education, administration, leadership, and Quality Management Performance Improvement (QM/PI) experience preferred. Basic computer literacy proficiency with the use of Microsoft Office programs or comparable word processing, spreadsheet and graphic software and the ability to learn new programs specific to the VA preferred. Ability to work variable and flexible tours to meet program demands. Demonstrated ability to accurately implement policies, regulations, standards of care and standards of practice preferred. Demonstrated ability to review patient clinical records. Proven ability to facilitate group problem solving preferred. Proven ability to utilize sound judgment in making patient transfer decisions preferred. Ability to lead and effectively direct staff within program unit/team/group preferred. Excellent organizational, communication, writing, and time management skills preferred. Excellent interpersonal skills and the ability to work independently as well as collaboratively with multiple service lines and disciplines preferred. Compensation: $60.00 - $75.00 per hour PROVIDING QUALITY STAFFING AND CONSULTING SINCE 2011 Based out of San Antonio, Tex as, our minority women-owned company specializes in all staffing and consulting needs. Whether you're trying to hire a pharmacist, a respiratory therapist, or skilled and non-skilled laborer, we will staff your company with the best candidate. We bring extensive experience and professionalism and we will personalize our assistance to your needs and concerns. Most of our contracts are with the Army and Air Force as Sub-Contractors. Our staff has a quick turn around and have been able to fill positions within 48 hours with short notice, we have filled hard to fill locations and jobs, and managed over 16 contracts with over 70 employees at a time. Managed call-ins at 24/7 hospitals and ensured shifts were filled, and managed PRNs with notice of less than 24 hours. Also, provided temp laborers for next day jobs. Our consulting division provides contracting assistance, program managing, application assistance, certification assistance and proposal writing. We are very knowledgeable in a variety of areas and are eager to assist your company's prosperity.

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work schedule: Monday - Friday 9:30am - 6pm local time, with rotating weekends. (Saturday 8am-12pm CST, with a comp day during the week) The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. * RN Compact License is strongly preferred; CA RN License is also preferred. * Experience in cardiology/radiology is preferred but not required. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $36.27 to $56.77 Locations: California. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work schedule: Monday - Friday 9:30am - 6pm local time, with rotating weekends. (Saturday 8am-12pm CST, with a comp day during the week) The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with more senior colleagues to complete non-routine reviews. Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. Notifies ordering physician or rendering service provider office of the preauthorization determination decision. Follows-up to obtain additional clinical information. Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences : Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. BA/BS degree preferred. Previous utilization and/or quality management and/or call center experience preferred. RN Compact License is strongly preferred; CA RN License is also preferred. Experience in cardiology/radiology is preferred but not required. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $36.27 to $56.77 Locations: California. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen-not dilute-our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve. Job Description: SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 300,000 members in California, Arizona, Nevada, Texas, New Mexico & Washington. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit ********************* *********************** or follow us on LinkedIn, Facebook, and Twitter. The Job Provide clinical review of medical claims and post service appeals. Facilitate appropriate investigation of issues and management of medical services and benefits administration while maintaining SCAN timeframe standards. You Will Review and analyze pre and post payment of complex health care claims from a medical perspective. Perform audits/reviews of medical claims per established criteria, identify need for medical record review, necessary documentation to support decision making process regarding appropriateness of claim, billed charges, benefit coverages Provide guidance to other staff members and accurately interpret and apply broad Centers for Medicare and Medicaid Services (CMS) guidelines to specific and highly variable situations Conduct review of claims data and medical records to make clinical decisions on the coverage medical necessity, utilization, and appropriateness of care per national and local policies as well as accepted medical standards of care) as assigned and as necessary and appropriate Process workload and complete project work in the appropriate computer system(s). Contribute to team effort by accomplishing related results as needed.Route identified clinical and/or risk issues to appropriate personnel eg, Medical Director, Quality of Care (QOC) Nurse, Medical Management Specialist, Member Services, etc Review/prepare potential claims denials in conjunction with Medical DirectorCollaborate with Medical Director pursuant to adjudication of claims and post service appeals Participate in special projects/workgroups/committees (eg, interdisciplinary workgroups, report analysis, independent review entity (IRE) etc. as assigned and as necessary and appropriate. We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. Actively support the achievement of SCAN's Vision and Goals. Other duties as assigned. Your Qualifications - Associate's Degree or equivalent experience required- Current and active California RN License in good standing required- Bachelor's Degree or equivalent experience preferred- Certified Professional Coder preferred.- 3-5 years of related experience in clinical decision making relative to Medicare patients.- Certifications deemed to be reasonable to function at this level.- Performs work under minimal supervision.- Handles complex issues and problems and refers only the most complex issues to higher-level staff.- Possesses comprehensive knowledge of subject matter.- Technical expertise - Strong technical skills for functional area - Problem Solving - Strong problem-solving skills - Communication - Good communication and interpersonal skills- Ability to work as part of a team. - Oral and written communication skills. - Problem-solving skills. - Attentiveness. - Interpersonal skills What's in it for you? Base salary range: $38.61 to $55.86 per hour Remote position An annual employee bonus program Robust Wellness Program Generous paid-time-off (PTO) Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday Excellent 401(k) Retirement Saving Plan with employer match and contribution Robust employee recognition program Tuition reimbursement An opportunity to become part of a team that makes a difference to our members and our community every day! We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now! At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more. SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-CS2 #LI-Remote Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and passion for making a difference. We support a culture focused on teamwork, support, and inclusion. We offer a flexible work environment and schedules with work from home options. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. Additional employee paid coverage options available. We also offer paid holidays, birthday off, and unlimited PTO as well as a 401k plan. Job purpose As a Concurrent Review Nurse, you will be responsible for coordinating and overseeing the care of patients receiving inpatient medical services. Working closely with healthcare providers, patients, and their families, you will ensure that patients receive comprehensive and coordinated care, promote continuity of care, and optimize patient outcomes. Duties and responsibilities The role of the concurrent review nurse to provide patient advocacy through appropriate utilization of services. Manage inpatient cases to ensure that medical care is medically necessary by conducting concurrent review and retrospective review for appropriateness of admission, level of care and determines length of stay. Overall planner of utilization efforts to effectively manage care from admission to discharge. Communicates with the facilities to get clinical information. Communicates with the facilities to get coordinate discharge planning for the member. Conduct case review based on criteria (InterQual or MCG) and makes a determination based on turnaround times established by the company. Comply with UM policies and procedures. Annual review of UM policies. Maintains Interrater Reliability Rate at least 95% or above. Act as clinical resources to all departments. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization or appropriate services to our patients. Attend to provider and interdepartmental calls in accordance with exceptional customer service. Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers and members. Always maintain strict confidentiality. Other duties as needed. Qualifications Current licensure or certification as a Registered Nurse (RN), Licensed Vocational Nurse. depending on the jurisdiction and requirements. CM and/or UM training and/or certification. Strong Knowledge of Medicare, Commercial and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning. Working knowledge of common diagnoses, procedures and diagnostic codes. Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements models such as DRGs, Full Risk, etc. Strong understanding of the criteria, rules and regulations around inpatient, Observation and Outpatient levels of patient management. A high degree of self-directed organizational skills, ability to set priorities, manage multiple demands and the ability to work independently and as a part of a multidisciplinary team. Able to work in a variety of computer programs, including InterQual, Ezcap, and Microsoft. Five years+ clinical experience. Prefer two (2) years+ experience in an HMO/IPA/Managed care setting is preferred and recommended. Commitment to patient-centered care, cultural competence, and ethical practice. Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe Detail oriented and highly organized. Strong ability in problem-solving Ability to manage self-manage, strong time management skills. Ability to work in an extremely confidential environment. Strong written and verbal communication skills Salary Range: $70,000 - $95,000 annually (LVN) depending on experience $85,000 - 120,000 annually (RN) depending on experience

RN Utilization Review at Irvine, CA. This position is Per Diem and will work Remote 8-hour, Day shifts. Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans. This role requires a strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications: + Associate's Degree in Nursing + Upon hire: California Registered Nurse License + 2 years experience working in a remote UR environment or working as an acute hospital case manager. Preferred Qualifications: + Bachelor's Degree in Nursing + Master's Degree in Nursing + Experience working with Interqual guidelines. + Experience in a multi-hospital and/or integrated healthcare system. Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 412476 Company: Providence Jobs Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Part time Job Shift: Multiple shifts available Career Track: Nursing Department: 7000 UTILIZATION MGMT OCHD Address: CA Irvine 15480 Laguna Canyon Rd Work Location: Providence System Offices Discovery Park-Irvine Workplace Type: On-site Pay Range: $56.44 - $87.63 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Voted one of the best companies to work for by Modern Healthcare Magazine: Renew Health Consulting Services is an award winning family company providing healthcare services including skilled nursing, assisted living and senior living communities. We believe that seniors are extraordinary people. Their lives are filled with achievements, contributions and wisdom. They have raised families, served their communities and country, lived history and ultimately set the stage for us. We are honored to provide their care, as they make the transition to the golden years, and when it becomes more challenging to care for one's self. From a short-term rehabilitation stay to long term nursing care, each of our clinical programs are designed to reduce hospitalizations so our patients can focus on achieving their individual care plan goals whether it's returning home or staying with us for their long term care needs Our commitment to superior quality of life is evident when you visit our family of centers. At our care center you will meet compassionate and professional team members who understand that finding the right skilled nursing setting and long-term care option could be difficult and confusing and are wanting to make a difference by providing the utmost care to genuinely help our patients and the community around them. If this sounds like a great fit for you, we would love to have you join our wonderful team! Compensation & Benefits: As a growing and essential company, we have many opportunities for growth and development within the medical industry and are committed to providing the resources and training you need. Pay is market competitive and negotiable based on your experience. Full-time employees will be eligible for a variety of comprehensive medical, dental, and vision insurance plans. Full-time employees will be eligible for Tuition Assistance. 401K. Travel Allowance The anticipated pay range for candidates who will work in California is $150K to $180K annually . The offered pay to a successful candidate will be dependent on several factors that may include but are not limited to years of experience within the job, years of experience within the required industry, education, etc. We are looking for full-time RN MDS Consultant Responsibilities: Responsible for visiting facilities in the assigned Region(s) on a regular basis and ensuring the accurate and timely submission of patient assessments, care planning, and billing processes that comply with the Patient-Driven Payment Model (PDPM). Conduct comprehensive assessments of patient's clinical needs and identify potential PDPM coding opportunities. Collaborate with interdisciplinary teams to develop patient-centered care plans that optimize clinical outcomes and maximize reimbursement under PDPM. Analyses and organizes PDPM and case mix data to ensure appropriate utilization of resources. Review medical documentation to ensure completeness, accuracy, and compliance with CMS regulations. Monitor and analyze PDPM-related data, including patient outcomes, revenue, and compliance metrics, and provide regular reports to senior leadership. Coordinate with MDS to ensure accurate completion of all MDS assessments and any supporting assessments or clinical documentation. Ongoing QA of medical records for the presence of supporting documentation for all items coded on the MDS. Provide education and training to staff on PDPM and related topics, including coding, documentation, and care planning Serve as a subject matter expert on PDPM to internal and external stakeholders, including regulatory bodies, payers, and auditors. Participate in quality improvement initiatives to enhance patient care and optimize reimbursement under PDPM. Maintain up-to-date knowledge of PDPM regulations and industry best practices and share this information with the facility and management. Qualifications: Bachelor's degree in nursing or related clinical field Active RN license or relevant clinical licensure. Experience with MDS completion preferred. Minimum of 3-5 years of clinical experience in a healthcare setting. Experience with Federal Medicare Skilling and Long term care billing. In-depth knowledge of the PDPM reimbursement system and CMS regulations. Submit your application and join our award-winning team! We are an equal opportunity employer and we are committed to Equal Employment Opportunity regardless of race, color, national origin, gender, sexual orientation, age, religion, veteran status, disability, history of disability or perceived disability, and per the Fair Chance Ordinance will consider qualified applications with criminal histories in a manner consistent with the ordinance. INDHP JOB CODE: Renew

TYPE OF RECRUITMENT OPEN COMPETITIVE JOB OPPORTUNITY EXAM NUMBER Y5701F THIS ANNOUNCEMENT IS A REPOSTING TO UPDATE THE ESSENTIAL JOB FUNCTION TO EXAMPLES OF DUTIES AND UPDATE THE EXAMINATION CONTENT INFORMATION. FILING START DATE 8/10/2020 at 9:00 A.M. (PT) This examination will remain open until the needs of the service are met and is subject to closure without prior notice. DEFINITION: Consults with administrative, medical, and nursing personnel in hospitals, skilled nursing facilities, and related health facilities to assist them in achieving compliance with State and Federal nursing regulations, and with the professional staff of the County Health Facilities Inspection Division in evaluating nursing services provided by licensed health care facilities. ABOUT LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES The Los Angeles County Department of Health Services (DHS) is the second-largest municipal health system in the nation. Through its unified system of 23 health centers and four hospitals, as well as its expanded network of community partner clinics, DHS annually provides direct care to over 500,000 patients, employs more than 23,000 staff, and has an annual budget exceeding $8.4 billion. Through academic affiliations with the University of California, Los Angeles (UCLA), the University of Southern California (USC), and the Charles R. Drew University of Medicine and Science (CDU), DHS hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services (EMS) Agency and the County's 911 emergency response system, as well as Housing for Health and the Office of Diversion and Re-entry, each with a critical role in connecting vulnerable populations, including those released from correctional and institutional settings, to supportive housing. MISSION: Our mission is to enhance the health of our patients and communities by delivering exceptional care.EXAMPLES OF DUTIES: * Conducts audits, special studies, and critical reviews of clinical practices and process, to assess compliance with regulatory and legal mandates. * Collects data necessary for the evaluation of infection prevention and control efforts from various sources including the medical record, laboratory results, etc. * Acts as facility liaison for system wide programs focused on infection prevention and control. * Provides staff support to Infection Control, QI, Patient Safety, and Risk Management related committees. * Conducts surveys to measure clincal practice outcomes, and in consultation with stakeholders formulates solutions to improve outcomes. The survey process includes preparing survey questions, distributing surveys, following up on facility/program responses, and compiling and analyzing summary data. * Functions as a Just Culture expert to provide consultation to facilities in the use and interpretation of the Just Culture model. Provides facility training in Just Culture concepts when requested. * Assists with Risk Management and Patient Safety related functions, including staffing DHS' Risk Management and Patient Safety committees. * Provides professional consultation to health facility administrators and nursing staff in the interpretation of laws, regulations and standards governing licensing, accreditation and certification for Medicare and Medi-Cal and in various acceptable methods of maintaining, improving, or modifying nursing operations. * Plans, develops, and conducts orientation and in-service training sessions for Division staff, conducts and participates in educational programs for health facility administrators, nurses and other health professionals, and develops guidelines and manuals for use in interpreting requirements for nursing care services. * Conducts both internal and external surveys to determine standards of practice which includes preparing survey questions, distributing surveys, following up on facility/program responses, and compiling summary data. * Visits health facilities and evaluates the quality of nursing service and compliance with laws and regulations; Notifies facilities in writing of findings and recommendations for correction of deficiencies, monitoring progress toward implementation of recommendations. * Conducts audits, performs special studies and critical reviews of medical record, such as adverse event investigations, Joint Commission National Patient Safety Goal audits, and risk management audits to confirm compliance with facility enacted corrective actions. * Functions as the chairperson for the Infection Control Committee, Quality Improvement Committee and Emergency Preparedness Subcommittee, which includes assisting department managers and directors to organize, interpret, and present data for committee meetings; Plans agendas and prepares minutes for the monthly Quality Improvement and Infection Control committee meetings. * Assists in departmental improvement projects such as those related to hospital acquired pressure injuries, falls, workplace violence, etc. * Performs reviews and critical analyses of Safety Intelligence (SI) incident reports submitted by facility frontline staff, to assess for appropriateness and thoroughness based on departmental policies. Identifies and notifies DHS Risk Management staff of events that may meet external reporting criteria such as CDPH Adverse Events and/or those that are at high risk for litigation. * Updates and revises program materials, such as the "Patient Safety & Risk Management Handbook". Creates Patient Safety and Risk Management educational materials for facility staff. * Maintains liaison with State and Federal agencies and professional organizations in connection with the development, analysis and interpretation of legislative and regulatory material in the area of nursing and its application to licensed health care facilities. SELECTION REQUIREMENTS: Option I: Five (5) years of experience as a Registered Nurse including two (2) years of experience in an administrative*, Supervisory, or consultative* capacity. OR Option II: A Master's Degree in Nursing from an accredited college or university AND four (4) years of experience as a Registered Nurse including two (2) years of experience in an administrative*, supervisory, or consultative* capacity. LICENSE: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing. Please ensure the certificates and licenses section of the application is completed. Provide the type of the required license(s), the number(s), the date(s) of issue, the date(s) of expiration and the name(s) of the issuing agency for each license as specified in the Selection Requirements. Applicants claiming experience in a state other than California must provide their Registered Nurse License Number from that state on the application at the time of filing. Applications submitted without the required evidence of licensure will be considered incomplete. Required license(s) and/or certification(s) must be active and unrestricted, or your application will not be accepted. Additionally, in order to receive credit for license(s) and/or certification(s) in relation to any desirable qualifications, the license(s) and/ or certification(s) must be active and unrestricted. Successful applicants for positions that require driving must obtain and present a copy of his/her driving record from the California State Department of Motor Vehicles before final appointment. Applicants should not present a copy of their driving history until asked to do so by the hiring department. The County will make an individualized assessment of whether an applicant's driving history has a direct or adverse relationship with the specific duties of the job. License must not be currently suspended, restricted, or revoked. PHYSICAL CLASS: II - Light: Light physical effort which may include occasional light lifting to a 10-pound limit, and some bending, stooping or squatting. Considerable walking may be involved. SPECIAL REQUIREMENT INFORMATION: * Administrative capacity is defined as performing in an administrative services branch of an organizational unit, including responsibility for the development of procedures and participation in policy formulation. Supervisory capacity is defined as planning, assigning, reviewing the work of staff, and evaluating employee performance. * Consultative capacity is defined as an expert in a specialized field, expressing views, providing opinions, and recommending courses of action to be taken on problems presented by others for resolution. In order to receive credit for any college course work, or any type of college degree, such as master degree, you must include a legible copy of the official diploma or official transcripts which shows the area of specialization with your application at the time of filing or within 15 calendar days of filing. DESIRABLE QUALIFICATIONS: Additional credit will be given to applicants who possess the following desirable qualifications: * Experience working as a Registered Nurse in a Risk Management, Quality Improvement, Patient Safety or Infection Control department. * Experience as a Registered Nurse surveying, investigating, inspecting and evaluating hospitals, skilled nursing facilities and other health facilities, clinics and/or individual providers for conformity with and enforcement of Federal and State licensing and certification requirements relating to the quality of medical care. EXAMINATION CONTENT: This examination will consist of an evaluation of education and experience based upon application information, desirable qualifications, and supplemental questionnaire, weighted at 100%. Candidates must meet the selection requirements and achieve a passing score of 70% or higher on this examination in order to be placed on the eligible register. ELIGIBILITY INFORMATION: Applications will be processed on an "as received" basis and those receiving a passing score will be promulgated to the eligible register in the order of their score group for a period of twelve (12) months following the date of eligibility. No person may compete in this examination more than once every twelve (12) months. AVAILABLE SHIFT: Appointees may be required to work any shift, including evenings, nights, weekends and holidays. VACANCY INFORMATION: The resulting eligible register for this examination will be used to fill vacancies throughout the Department of Health Services as they occur. APPLICATION AND FILING INFORMATION: Applications must be filed online only. Applications submitted by U.S. mail, Fax, or in person will not be accepted. Applications electronically received after 5:00 p.m., PT, on the last day of filing will not be accepted. Apply online by clicking the "APPLY" green button at the top right of this posting. You can also track the status of your application using this website. The acceptance of your application depends on whether you have clearly shown that you meet the SELECTION REQUIREMENTS. Fill out your application and supplemental questionnaire completely to receive full credit for related education and/or experience in the spaces provided so we can evaluate your qualifications for the job. Please do not group your experience, for each position held, give the name and address of your employer, your position title, beginning and ending dates, number of hours worked per week, and description of work performed. If your application is incomplete, it will be rejected. IMPORTANT NOTES: * Please note that All information supplied by applicants and included in the application materials is subject to VERIFICATION. We may reject your application at any point during the examination and hiring process, including after an appointment is made. * FALSIFICATION of any information may result in DISQUALIFICATION. * Utilizing VERBIAGE from Class Specification and/or Selection Requirements serving as your description of duties WILL NOT be sufficient to demonstrate that you meet the requirements. Comments such as "SEE RESUME" or "SEE APPLICATION" will not be considered as a response; in doing so, your application will be REJECTED. * It is recommended that you provide your work experience using statements that provide the following three elements: ACTION you took, the CONTEXT in which you took that action, and the BENEFIT that was realized from your action. Include specific reference to the impact you made in the positions you have held. NOTE: If you are unable to attach documents to your application, you must email the documents to the Exam Analyst, Sylvia Jaimez at ************************ within 15 calendar days of filing online. Please ensure to reference your attachment(s) by including your full name, examination number and examination title in the subject of your email. SOCIAL SECURITY NUMBER LANGUAGE: Please include your Social Security Number for record control purposes. Federal law requires that all employees have a Social Security Number. COMPUTER AND INTERNET ACCESS AT PUBLIC LIBRARIES: For candidates who may not have regular access to a computer or the internet, applications can be completed on computers at public libraries throughout Los Angeles County. NO SHARING USER ID AND PASSWORD: All applicants must file their applications online using their own user ID and password. Using a family member or friend's user ID and password may erase a candidate's original application record. FAIR CHANCE INITIATIVE The County of Los Angeles is a Fair Chance employer. Except for a very limited number of positions, you will not be asked to provide information about a conviction history unless you receive a contingent offer of employment. The County will make an individual assessment of whether your conviction history has a direct or adverse relationship with the specific duties of the job, and consider potential mitigating factors, including, but not limited to, evidence and extent of rehabilitation, recency of the offense(s), and age at the time of the offense(s). If asked to provide information about a conviction history, any convictions or court records which are exempted by a valid court order do not have to be disclosed. ADA COORDINATOR: ************** CALIFORNIA RELAY SERVICES PHONE: ************** DEPARTMENT CONTACT: Sylvia Jaimez, Exam Analyst Telephone Number: ************** Email Address: ************************

ER travel nurse job in Los Angeles, CA - earn $2,722/week on a 13 week, Nights shift at a travel-friendly hospital with Advantis Medical. Looking for ER travel nursing jobs near you? This contract follows a (3×12) schedule and offers high pay, clinical experience, and the full support of the #1 rated travel nurse agency. Whether you're planning your next assignment in California or searching for "ER travel RN jobs near me", this opportunity could be the perfect fit. This travel assignment is perfect for nurses looking to be near Los Angeles, CA. Don't miss out-click "I'm Interested" to start your application and connect with an Advantis recruiter to explore more travel ER nurse jobs near you. Job Details Facility: Hollywood Presbyterian Location: Los Angeles, CA 90027 Explore the area! See our local guide and an interactive map further down this page. Contract Length: 13 Weeks Shift: Nights (3×12) Travel Nursing Requirements: 2+ years of recent ER nursing experience. Active California RN License or Compact License (if applicable) Benefits Day One Benefits - Medical, Dental, Vision & 401(k) Relocation and Travel Reimbursement Dedicated team to help with travel & housing accommodations Weekly Direct Deposit $500 Referral Bonuses Near Los Angeles, CA Los Angeles, CA is one of the nation's busiest healthcare hubs, where assignments stretch across a wide metro and diverse patient populations. Off the clock, hike through Griffith Park to its observatory for sweeping city views, or unwind at the Santa Monica Pier. The city's coastline and museum districts provide countless ways to recharge between shifts. For clinicians pursuing travel RN jobs near me, opportunities remain steady in hospitals and specialty centers throughout the region. Travel Nursing jobs also extend into nearby Pasadena, Long Beach, and Burbank. Blending cultural variety with consistent professional demand, Los Angeles, California offers healthcare travelers a setting as dynamic as the city itself. FAQs - ER Travel Nurse Jobs Near Los Angeles, CA Expand All Are there ER travel nursing jobs near Los Angeles, California? Yes! Advantis Medical frequently staffs ER travel RN jobs in Los Angeles and nearby areas like Long Beach (90802), Anaheim (92805) and Pasadena (91101). This assignment offers $2,722 per week and is one of our top current opportunities. Is Los Angeles a good location for ER travel nursing jobs? Yes. With competitive pay, career-boosting clinical environments, and great local lifestyle perks, Los Angeles is a top destination for ER travel nurse jobs in California. What certifications are required for this ER travel nurse position? Most travel ER jobs require Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS), with Pediatric Advanced Life Support (PALS) often needed if pediatric patients are involved. Many facilities also prefer the Trauma Nursing Core Course (TNCC), though it's not always required. Specific requirements vary by unit-click "I'm Interested" to connect with a professional recruiter who can walk you through the exact certifications needed for this role. Can I work as a travel nurse in California with a compact nursing license? California Board of Nursing Contact information Website: https://www.rn.ca.gov/ Phone: 916.322.3350 Fees License by Exam: $150 (+$200 exam fee) License by Endorsement: $150 Fingerprinting: $49 Temporary License: $50 Timing Processing Time: 3 - 6 months Valid for: 2 years Renewal Schedule: every 2 years, by your birthday General Information Nurse Licensure Compact: No Nursys: Yes CEU Requirements: CEU Requirements: 30 hours Helpful Links Apply Now Check Status Verify License License Renewal Travel Nursing Jobs With Advantis Medical - The Gold Standard At Advantis Medical Staffing, we take great pride in our commitment to caring for travel nurses. We are dedicated to connecting nurses with the best travel nursing jobs nationwide, while providing exceptional service that fosters a trusted partnership for life. Our mission is to deliver the "Gold Standard" in service -not only by securing your first assignment but by advocating for your long-term career goals and well-being. Experience our gold standard level of service as we create a stress-free and rewarding journey for you. View Similar ER Jobs ⟶ Travel Nursing Job in Los Angeles, CA Weekly Pay: $2,722 This pay combines taxable wages and tax-free stipends. For a full, transparent breakdown, submit the "I'm Interested" form, & a recruiter will send you the details. × Location: Los Angeles, CA 90027 Explore the area! See our local guide and an interactive map further down this page. × Facility: Hollywood Presbyterian Specialty: ER Duration: 13 weeks Shift: Nights (3x12) I'm Interested Have a question? Call us at 214-305-6445

The **Nurse Reviewer** is responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with more senior colleagues to complete non-routine reviews. Through work experience and mentoring, learns to conduct medical necessity clinical screenings of preauthorization request to assess the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. **Schedule: This position is full time and must include every weekend** **Location:** **Virtual -** This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. **How you will make an impact:** - Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. - Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. - Notifies ordering physician or rendering service provider office of the preauthorization determination decision. - Follows-up to obtain additional clinical information. - Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. **Minimum Requirements:** - Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. - Current unrestricted RN license in applicable state(s) required. **Preferred Skills, Capabilities, and Experiences:** - Familiarity with Utilization Management Guidelines, ICD-10 and coding, and managed health care including HMO, PO and POS plans strongly preferred. - BA/BS degree preferred. - Previous utilization and/or quality management and/or call center experience preferred. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $31.54 - $47.31 Locations: California In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._ * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Job Description Voted one of the best companies to work for by Modern Healthcare Magazine: Renew Health Consulting Services is an award winning family company providing healthcare services including skilled nursing, assisted living and senior living communities. We believe that seniors are extraordinary people. Their lives are filled with achievements, contributions and wisdom. They have raised families, served their communities and country, lived history and ultimately set the stage for us. We are honored to provide their care, as they make the transition to the golden years, and when it becomes more challenging to care for one's self. From a short-term rehabilitation stay to long term nursing care, each of our clinical programs are designed to reduce hospitalizations so our patients can focus on achieving their individual care plan goals whether it's returning home or staying with us for their long term care needs Our commitment to superior quality of life is evident when you visit our family of centers. At our care center you will meet compassionate and professional team members who understand that finding the right skilled nursing setting and long-term care option could be difficult and confusing and are wanting to make a difference by providing the utmost care to genuinely help our patients and the community around them. If this sounds like a great fit for you, we would love to have you join our wonderful team! Compensation & Benefits: As a growing and essential company, we have many opportunities for growth and development within the medical industry and are committed to providing the resources and training you need. Pay is market competitive and negotiable based on your experience. Full-time employees will be eligible for a variety of comprehensive medical, dental, and vision insurance plans. Full-time employees will be eligible for Tuition Assistance. 401K. Travel Allowance The anticipated pay range for candidates who will work in California is $150K to $180K annually . The offered pay to a successful candidate will be dependent on several factors that may include but are not limited to years of experience within the job, years of experience within the required industry, education, etc. We are looking for full-time RN MDS Consultant Responsibilities: Responsible for visiting facilities in the assigned Region(s) on a regular basis and ensuring the accurate and timely submission of patient assessments, care planning, and billing processes that comply with the Patient-Driven Payment Model (PDPM). Conduct comprehensive assessments of patient's clinical needs and identify potential PDPM coding opportunities. Collaborate with interdisciplinary teams to develop patient-centered care plans that optimize clinical outcomes and maximize reimbursement under PDPM. Analyses and organizes PDPM and case mix data to ensure appropriate utilization of resources. Review medical documentation to ensure completeness, accuracy, and compliance with CMS regulations. Monitor and analyze PDPM-related data, including patient outcomes, revenue, and compliance metrics, and provide regular reports to senior leadership. Coordinate with MDS to ensure accurate completion of all MDS assessments and any supporting assessments or clinical documentation. Ongoing QA of medical records for the presence of supporting documentation for all items coded on the MDS. Provide education and training to staff on PDPM and related topics, including coding, documentation, and care planning Serve as a subject matter expert on PDPM to internal and external stakeholders, including regulatory bodies, payers, and auditors. Participate in quality improvement initiatives to enhance patient care and optimize reimbursement under PDPM. Maintain up-to-date knowledge of PDPM regulations and industry best practices and share this information with the facility and management. Qualifications: Bachelor's degree in nursing or related clinical field Active RN license or relevant clinical licensure. Experience with MDS completion preferred. Minimum of 3-5 years of clinical experience in a healthcare setting. Experience with Federal Medicare Skilling and Long term care billing. In-depth knowledge of the PDPM reimbursement system and CMS regulations. Submit your application and join our award-winning team! We are an equal opportunity employer and we are committed to Equal Employment Opportunity regardless of race, color, national origin, gender, sexual orientation, age, religion, veteran status, disability, history of disability or perceived disability, and per the Fair Chance Ordinance will consider qualified applications with criminal histories in a manner consistent with the ordinance. INDHP

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus