Utilization review nurse jobs in California - 2,414 jobs

Posted 30+ days ago $53 - $78/hr Ranges shown should be used as an estimate and are affected by many factors including the critical need of the position, your overall experience and qualifications, and other considerations. Please reach out to your consultant for more information. Permanent Central, California Quick Facts Bachelor's degree required preferably in nursing 3 years leadership experience required Generous compensation Relocation assistance Benefits package

NP/PA Aesthetic Injector- Medical Aesthetics Practice 📍 Beverly Hills, CA | 💼 Full-Time / Part-Time 💵 Compensation : $60-$75/hour 💵 Performance-Based Incentives | Premier Beverly Hills Practice Dr. John Diaz, MD is a premier medical aesthetics practice dedicated to helping clients look and feel their best through innovative, safe, and results-driven treatments. We pride ourselves on delivering exceptional patient care, personalized treatment plans, and a luxury experience in a professional and welcoming environment. Position Overview We are seeking a skilled and passionate Injector (Nurse Practitioner or Physician Assistant) to join our growing team. The ideal candidate has a strong background in aesthetics, a natural eye for beauty and balance, and a commitment to patient safety. You will perform injectable treatments including neuromodulators, dermal fillers, and other advanced procedures while ensuring the highest standard of patient satisfaction. Key Responsibilities Conduct patient consultations, assess client needs, and develop personalized treatment plans Administer injectable treatments (neuromodulators, dermal fillers, PRP, etc.) with precision and care Educate clients on treatment options, post-care instructions, and long-term maintenance Build and maintain strong client relationships to encourage loyalty and referrals Maintain accurate patient documentation in compliance with medical and regulatory guidelines Stay current on the latest trends, techniques, and safety protocols in aesthetics Collaborate with the clinical team to provide a seamless, luxury patient experience Qualifications Active and unrestricted NP or PA license in California Minimum 2+ years of experience in aesthetics (injectables required) Demonstrated proficiency with neuromodulators and dermal fillers Exceptional communication and interpersonal skills Strong aesthetic judgment and attention to detail Commitment to patient safety, education, and satisfaction Preferred Skills Experience with additional services such as PDO threads, PRP, Kybella, lasers, etc. Consultation and sales experience in a medspa or aesthetic practice Continuous learner mindset and passion for advancing aesthetic skills Why Join Us? Competitive base pay plus performance-based incentives Opportunities for advanced training and professional growth Employee discounts on treatments and products Work alongside a renowned physician in a luxury, patient-focused environment Supportive, collaborative, and high-performing team culture 👉 If you are a talented Injector (NP or PA) passionate about aesthetics and ready to elevate your career in Beverly Hills' premier medical aesthetics practice, we want to hear from you. Apply today to join Dr. Diaz's team and help deliver exceptional patient care and results! #J-18808-Ljbffr

Event Details Join us for an Interview and Hiring Day! Registered Nurses welcomed! Time: 9:00 am to 2:00 pm Directions/Parking: Our main lobby entrance is located at 1680 E 120th Street, Los Angeles, CA 90059. The entrance to the parking lot is on Healthy Way at the north side of our building, behind the large sculpture. Our hospital is easily accessible by public transportation and car. Please note: Interview times are first come first serve and you will be required to check in once you arrive at the event. Click RSVP Now to get started This event is for experienced Registered Nurses. Here's why it's great to be a nurse at MLKCH MLK Community Healthcare has a culture of nursing like no other. We have a compelling mission to improve the health of an appreciative and truly deserving community. We support our nurses with tools, training and best-in-class resources. Our fantastic new RN Residency Program launches recent graduates on a path to success. Our staff fellowships for experienced nurses open doors to new fields of expertise and leadership training at the highest level. And we offer competitive pay and unbeatable benefits. The result? Inspirational careers and the chance to make a meaningful difference in the lives of the most vulnerable.

ABOUT MARINHEALTH Are you looking for a place where you are empowered to bring innovation to reality? Join MarinHealth, an integrated, independent healthcare system with deep roots throughout the North Bay. With a world-class physician and clinical team, an affiliation with UCSF Health, an ever-expanding network of clinics, and a new state-of-the-art hospital, MarinHealth is growing quickly. MarinHealth comprises MarinHealth Medical Center, a 327-bed hospital in Greenbrae, and 55 primary care and specialty clinics in Marin, Sonoma, and Napa Counties. We attract healthcare's most talented trailblazers who appreciate having the best of both worlds: the pioneering medicine of an academic medical center combined with an independent hospital's personalized, caring touch. MarinHealth is already realizing the benefits of impressive growth and has consistently earned high praise and accolades, including being Named One of the Top 250 Hospitals Nationwide by Healthgrades, receiving a 5-star Ranking for Overall Hospital Quality from the Centers for Medicare and Medicaid Services, and being named the Best Hospital in San Francisco/Marin by Bay Area Parent, among others. Company: Marin General Hospital dba MarinHealth Medical Center Compensation Range: $66.03 - $99.04 Work Shift: Day Shift (United States of America) Scheduled Weekly Hours: 40 Job Description Summary: The Utilization Review Nurse is responsible for completion of admission, concurrent and retrospective reviews for designated health plans. This function includes appropriate application of standardized criteria and concurrent documentation. As appropriate, the UR nurse will assess for clinical stability and coordinate transfer back to Marin General for continued care when patients are admitted to non-contracted hospitals. The UR nurse is also responsible for initial RAC review prior to submission to Physician Advisor and will appeal medical necessity denials. Denials submitted to the case management department from Patient Financial Services will be reviewed to determine if the medical record has sufficient medical necessity documentation prior to a written appeal. The UR nurse will escalate cases to the Medical Director (as necessary) to ensure the provision of appropriate and effective patient care. Job Requirements, Prerequisites and Essential Functions: EDUCATION Bachelor of Science degree in Nursing preferred EXPERIENCE 1. Three (3) or more years of experience in an acute patient care setting preferably in medical/surgical or critical care. 2. Substantial recent experience in utilization review and/or discharge planning in an acute care setting is strongly preferred. 3. Experience in applying evidence based criteria related to utilization management. 4. Experience using case management software LICENSURE AND CERTIFICATIONS Registered Nurse Required at hire Basic Life Support Required at hire PREREQUISITE SKILLS 1. Must have the ability to read, write, and follow English verbal and written instructions, and have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, and positive personal influence and negotiation skills. 2. Able to carry out review function and access medical records. 3. Must have the ability to work independently with a minimum of direction, anticipate and organize work flow, prioritize and follow through on responsibilities. 4. Utilization review/discharge planning services appropriate to patients with complex 5. Strong attention to detail and accuracy is required. 6. Must have the ability to work in a high volume case load environment and deal effectively with rapidly changing priorities. 7. Demonstrated ability to work constructively with a broad spectrum of health care professionals is required. 8. Must be assertive and creative in problem solving, system planning and management. 9. Proficient computer skills are required including use of Electronic Health Record. Microsoft Office Suite Products. Accommodation: Qualified applicants with disabilities may request reasonable accommodation during the application process by contacting Human Resources at ************ or ***********************************. C.A.R.E.S. Standards: MarinHealth seeks candidates ready to model our C.A.R.E.S. standards-Communication, Accountability, Respect, Excellence, Safety-which foster a healing, trust-based environment for patients and colleagues. Health & Immunizations: To protect employees, patients, and our community, MarinHealth requires measles, mumps, varicella, and annual influenza immunizations as a condition of employment (and annually thereafter). COVID-19 vaccination/booster remains strongly recommended. Medical or religious exemptions will be considered consistent with applicable law. Compensation: The posted pay range complies with applicable law and reflects what we reasonably expect to pay for this role. Individual pay is set by skills, experience, qualifications, and internal/market equity, consistent with MarinHealth's compensation philosophy. Positions covered by collective bargaining agreements are governed by those agreements. Equal Employment: All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sexual orientation, gender identity, protected veteran status or disability status, and any other classifications protected by federal, state, and local laws.

Location: 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. 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. Must be located in the state of California Schedule: 9:30am-6:00pm PST, ability to work weekends if necessary. New Grads are encouraged to apply! 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: * 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, PO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. * Knowledge in Microsoft office. For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $31.54/hr - $56.77/hr 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.

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.

Utilization Management Coordinator External Description: Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time. By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community. Position Summary: The Utilization Management (UM) Clerk will assist in the clerical support to the UM department staff (i.e. incoming/outgoing mail, data entry, filing, etc.) General Duties/Responsibilities: (May include but are not limited to) · Responsible for processing incoming and outgoing mail for the UM Department. · Maintains inventory of office supplies at a level necessary for proper functioning of the department. · Performs clerical duties deemed necessary to ensure smooth functioning of the department. · Performs data entry as requested. · Assist Inpatient team by entering Face Sheets and faxes. · Data integrity testing for new projects or project enhancement · Ensures delegated IPA/MGs provide CCHP with discharge dates, authorized days and discharge disposition on members assigned to delegated IPA/MG by faxing requests for information, tracking receipt of information and forwards information to Inpatient Team. · Call hospitals to obtain billing charges and maintain billing log. · Meets specific deadlines (responds to various workload by assigning task priorities according to department policies, standards, and needs). · Maintain Department miscellaneous filing in an organized fashion as well as create files as needed. · Recognizes work-related problems and contributes to solutions. · Maintains confidentiality of information between and among health care professionals. · Other duties as assigned by UM Management. Minimum Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Minimum Experience: a. Minimum of one-year in clerical support. 2. Education/Licensure: a. High school diploma or general education degree (GED) b. At least six months related experience and/or training; or equivalent combination of education and experience. 3. Other: a. Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. b. Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance. c. Typing speed 45 wpm and proficient use of 10-key calculator. d. Computer Skills: Microsoft Office. Knowledge of computer programs and applications required. e. Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. i. Excellent communication skills, oral and written. 4. Work Environment a. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. i. The noise level in the work environment is usually moderate. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. 2. The employee is frequently required to walk; stand; reach with hands and arms. 3. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl. 4. The employee must occasionally lift and/or move up to 20 pounds. 5. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************. City: Orange State: California Location City: Orange Schedule: Full Time Location State: California Community / Marketing Title: Utilization Management Coordinator Company Profile: Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time. By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community. EEO Employer Verbiage: On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.

Nature and Scope This multifaceted role will focus on discharge planning, utilization review, and swing bed coordination within our healthcare facility. The Case Manager will play a pivotal role in ensuring the smooth transition of patients from the acute care setting to appropriate post-acute care options, while also managing utilization and assisting swing bed services. Location We are located at 1065 Bucks Lake Road Quincy, CA 95971 Compensation Hourly Rate: $58.98 - $84.09 (based on clinical pay scale) Job Status / Shift Information Full-time, benefited Requried to be put on administration on call schedule Qualifications Experience: A Minimum of three (3) years' experience in case management and utilization management. Education: Bachelor's degree in a healthcare-related field (such as Nursing, or Healthcare Administration). Current healthcare licensure or relevant certification (e.g., RN or related lic.). Knowledge, Skills, and Abilities: Knowledge of insurance and Medicare/Medicaid regulations. Excellent communication and interpersonal skills. Strong organizational and time-management abilities. Ability to work collaboratively in a multidisciplinary healthcare team. Understanding of medical terminology and patient care. Excellent skills in crucial conversations, and emotional intelligence. Responsibilities Conduct comprehensive assessments of patients' medical, social, and financial needs to develop effective discharge plans. Collaborate with physicians, nurses, social workers, and other healthcare professionals to ensure that patients receive the most suitable and seamless post-acute care. Coordinate and facilitate family meetings to educate and involve patients and their families in the discharge planning process. Monitor and update discharge plans to address evolving patient needs and conditions. Review and assess the medical necessity and appropriateness of care provided to patients. Benefits / Perks Pay & Recognition Balanced Life Well-Being Professional Growth Dependent Care Child Care At PDH, we believe investing in our team matters. Our benefits and perks include medical, vision, dental, 401k, retirement, paid time off, discounted memberships with Flight/American Medical Care Network, housing stipend or paid housing for first 3 months of employment, shift differentials, and more! PDH Benefits to review more details on current options available Why Plumas District Hospital Work in a supportive, community-focused clinic environment surrounded by the beauty of the Sierra Nevada. Make a lasting impact on patient care while enjoying competitive pay and meaningful benefits. Contact Information Recruiter Name/Email: Nicholas Clawson Department Phone: ************

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

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)

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

Full-time Description Classification: Full-Time is non-exempt and will be paid on an hourly basis. Schedule: Monday-Friday 8am-5pm Benefits: · Medical · Dental · Vision · Simple IRA Plan with Employer Contribution · Employer Paid Life Insurance · Employee Assistance Program Compensation: The initial pay range for this position upon commencement of employment is projected to fall between $31.00 and $38.74 for a California Licensed LVN & $43.35 and $54.18 for a California Licensed RN. However, the offered base pay may be subject to adjustments based on various individualized factors, such as the candidate's relevant knowledge, skills, and experience. We believe that exceptional talent deserves exceptional rewards. As a committed and forward-thinking organization, we offer competitive compensation packages designed to attract and retain top candidates like you. Position Summary: Under the guidance of the Utilization Management, the UM Nurse Reviewer will leverage expertise to conduct timely reviews of pre-certification and/or concurrent requests, aligning with established policies. The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This role involves reviewing services to guarantee the fulfillment of medical necessity, applying clinical knowledge to ensure proper benefit utilization, facilitating secure and efficient discharge planning, and collaborating closely with internal and external stakeholders to address the multifaceted needs of the member. Requirements Job Duties and Responsibilities: • Performs utilization review activities, including pre-certification, concurrent, and/or retrospective reviews according to regulatory guidelines. • Reviews proposed hospitalization, home care, and inpatient / outpatient treatment plans for medical necessity and efficiency in accordance with CMS coverage guidelines. • Determines medical necessity of each request by applying appropriate medical criteria to designated level reviews and utilize approved evidenced-based guidelines or criteria. • Utilizes considerable clinical judgement, independent analysis, critical-thinking skills and detailed knowledge of medical policies, clinical guidelines, and benefit plans to complete reviews and determinations within required turnaround times specific to the case type. • Answers Utilization Management directed telephone calls, managing them in a professional and competent manner. • Refers case to Medical Reviewer when the request does not meet medical necessity per guidelines, or when guidelines are not available. • Reviews, documents, and communicates all utilization review activities and outcomes including, but not limited to, all calls made and received in regard to case communication and all demographic and service group information. • Sends appropriate system-generated letters to providers and members. • May provide guidance and coaching to other UM nurses and participate in the orientation of newly hired staff. • Identifies and refers all potential quality issues to the Clinical Quality Management Department, and suspected fraud and abuse cases to Compliance Department. • Identify and refer potential cases to Disease Management and Case Management Team. • For concurrent referrals, ensure that all post-discharge care is coordinated appropriately according to the needs of the member and ensures appropriate continuity of care. • Participates in Patient-Centered quality improvement initiatives. • Participates in monthly/quarterly and annual audits. • Maintain knowledge of DOFR (Disposition of Financial Responsibility), Medicare guidelines, MCG, InterQual, health plan guidelines, and other necessary UM resources. • Assist in developing workflows, job aid, standard operating procedures, and/or policies and recommend or change as appropriate to ensure timely, efficient, and effective outputs including NCQA, CMS, and other regulatory agencies. • Participates in data collection, health outcome reporting, clinical audits, and programmatic evaluations. • Supports patient care database by entering new information as it becomes available, verifying findings and backing-up data. • Track and trend patient care logs for all required health plans, as needed. • Ensures clinical documentation is thorough and includes information on transition of care needs of members transitioning from one level of care to another. • Works with the other support team personnel in a collaborative professional manner to best service the company. • Identifies high-risk members and conduct necessary interventions, which may include immediate follow-up with Primary Care Physician, community resources such as transportation assistance or programs such as Meals on Wheels for dietary support. • Presents member cases during Multidisciplinary Rounds to provide update and recommendations on member care status and needs to facilitate safe discharges and prevent avoidable delays during admissions. • Facilitates access to necessary care by navigating barriers and advocating for members, educating members and families/caregivers on the transition process, options for post-acute care and level set expectations while setting achievable, safe goals. • Provides technical support and serves as resource to PCP and specialists offices, providers, and members regarding healthcare needs and authorization process. • Performs all other related duties as assigned. Qualifications • Active Unrestricted Current California RN or LVN license • At least one year of managed care experience with prior experience in ambulatory case management, utilization management, disease management or any combination of education/ experience preferred. • Proficient in PC Software computer skills • ICD-10, CPT coding knowledge/experience preferred. • Medicare guidelines, InterQual, or MCG knowledge/experience preferred. • Excellent communication skills both verbal and written skills • Solid problem solving and analytical skills. • Ability to interact productively with individuals and with multidisciplinary teams with minimal guidance. • Possess planning, organizing, conflict resolution, negotiating, and essential interpersonal skills. Salary Description $31.00-54.18 Hourly/$64,480.00-112,710.00 Annually

TYPE OF RECRUITMENT: OPEN COMPETITIVE JOB OPPORTUNITY EXAM NUMBER: Y5126D This examination will remain open until the needs of the service are met and is subject to closure without prior notice. 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 integrated system of 25 health centers and four (4) acute hospitals and expanded network of community partner clinics - DHS annually provides direct care for 600,000 unique patients, employs over 23,000 staff, and has an annual budget of over $6.9 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 Sciences (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. For additional information regarding DHS please visit ******************** MISSION: To advance the health of our patients and our communities by providing extraordinary care. DEFINITION: Exercises, under medical direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the largest public hospitals in the country with 600-beds. CLASSIFICATION STANDARDS: The position allocated to this class is responsible for directing, through subordinate supervisors, the activities of the Utilization Review Nurses engaged in utilization review activities, in accordance with the Professional Standards Review Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the Utilization Review Committee, the incumbent is responsible for the development and implementation of procedures for and the effective conduct of the system to review patients' medical charts to ascertain the medical necessity for services and appropriateness of the level of care, for notification of appropriate persons of cases which do not meet medical necessity and level of care criteria, and for certification of approved hospital days reimbursable under the Medicare and MediCal programs. * Plans, develops, and implements procedures to fulfill the Professional Standards Review organization requirements for an effective and timely utilization review system. * Directs the utilization review function through subordinate supervisors, conferring with supervisors on personnel, and technical and administrative problems. * Reviews and analyzes reports prepared by subordinate supervisors on number and status of reviews, physician advisor referrals, and type of physician advisor determinations, to determine if improvement in procedures or additional staff training is needed and to make recommendations on potential areas for medical care evaluation studies. * Determines need for and conducts in-service training to improve quality of admission and continued stay reviews, and to disseminate information concerning new or revised procedures. * Evaluates the performance of subordinate supervisors and reviews their evaluations of Utilization Review Nurses; counsels subordinates on their performance. * Develops procedures for the compilation of information from medical charts concerning diagnoses, problems, procedures, or practitioner categories as directed for medical care evaluation studies. * Works with Professional Standards Review Organization representative to orient new staff to Federal laws and regulations pertaining to Medicare and Medi-Cal reimbursement. * Confers with physicians, administrative personnel, and other disciplines in the hospital to coordinate the work of the unit, obtain information, answer questions concerning the necessity for utilization review, and develop review procedures. * Attends Utilization Review Committee meetings to inform the Committee of new or revised utilization review requirements, the impact of the requirements, and procedures to be implemented for compliance. SELECTION REQUIREMENTS: 1. One (1) year experience within the last five (5) years in the supervision* of nursing staff engaged in utilization review activities. * AND- 2. Current certification issued by the American Heart Association's Basic Life Support (BLS) for Healthcare Providers (CPR & AED) Programs. LICENSE(S) AND CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing. Applicants must ensure the License and Certification Section of the application is completed. Provide the title(s) of your required license(s), the number(s), date(s) of issue, date(s) of expiration and the name(s) of the issuing agency for the required 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. Out-of-State experience provided on the application without the required license number will not be considered. 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. A current certification issued by the American Heart Association's Basic Life Support (BLS) for Healthcare Providers (CPR & AED) Program. Applicants MUST attach a legible photocopy of the required BLS certification to their application at the time of filing or within 15 calendar days of filing your application online. Applications submitted without the required evidence of BLS certification will be rejected. 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. SPECIALTY REQUIREMENTS: * For this examination, supervision MUST include all the following: planning, assigning, reviewing work of staff and evaluating employee performance. DESIRABLE QUALIFICATIONS: Credit will be given to applicants who possess the following desirable qualifications: * Experience within the last five (5) years in the supervision* of nursing staff engaged in utilization review activities beyond the selection requirements. * Bachelor of Science degree in Nursing (BSN) or higher from an accredited institution. In order to receive credit for any type of college degree, you MUST include a legible copy of the official degree, official transcripts, or official letter from the accredited institution which shows the area of specialization WITH your online application at the time of filing, or within 15 calendar days from the date of filing the application.EXAMINATION CONTENT The examination will consist of an evaluation of education and experience based upon application information and Desirable Qualifications, weighted 100% Candidates must achieve a passing score of 70% or higher on the examination in order to be placed on the eligible register. Notification Letters and other correspondences will be sent electronically to the email address provided on the application. It is important that applicants provide a valid email address. Please add ************************** and *********************** to your email address book and to the list of approved senders to prevent email notifications from being filtered as SPAM/JUNK mail. ELIGIBILITY INFORMATION: The names of candidates receiving a passing grade in the examination will be placed on the eligible register in the order of their score group for a period of twelve (12) months from the date of promulgation. Applications will be processed on an as received basis and promulgated to the eligible register accordingly. No person may compete for 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 a vacancy at the Comprehensive Health Centers and its affiliated Health Centers and any other 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. 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 and correctly 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: * All information supplied by applicants and included in the application materials is subject to VERIFICATION. * We may reject your application at any time during the examination and hiring process, including after appointment has been made. * FALSIFICATION of any information may result in DISQUALIFICATION or RECISSION OF APPOINTMENT. * 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. NOTE: Candidates who apply online must upload any required documents as attachments during application submission. If you are unable to attach required documents, you may email the documents to Alvonte Harraway at ************************** at the time of filing, or within 15 calendar days from the date of filing the application. Please include your Name, the Exam Number and Exam Title on the email. SOCIAL SECURITY NUMBER: Please include your Social Security Number for record control purposes. Federal law requires that all employed persons have a Social Security Number. 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 individualized 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. NO SHARING OF 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. ADA Coordinator Phone: ************** California Relay Services Phone: ************** DEPARTMENT CONTACT: Alvonte Harraway, Exam Analyst HR ESC phone number is ************** **************************

About us: Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ "Superior" by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide. Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path! Benefits: We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer! * Competitive compensation * Healthcare benefits package that begins on first day of employment * 401K retirement plan with company match * Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays * Up to 6 weeks of parental and bonding leave * Hybrid work schedule (3 days in the office, 2 days from home) * Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation) * Tuition reimbursement after 6 months of employment * Numerous opportunities for continued training and career advancement * And much more! Responsibilities The Utilization Review Nurse's duties will include, but are not limited to: * Support internal claims adjusting staff in the review of workers' compensation claims * Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone * Meet required decision-making timeframes * Clearly document all communication and decision-making within our insurance software system * Establish collaborative relationships and work as an intermediary between clients, patients, employers, providers, and attorneys * Utilize good clinical judgment, careful listening, and critical thinking and assessment skills * Track ongoing status of all UR activity so that appropriate turn-around times are met * Maintain organized files containing clinical documentation of interactions with all parties of every claim * Send appropriate letters on each completed UR Salary Range $65,000.00 - $100,000.00 USD The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training. Qualifications * Active Licensed Practical Nurse and/or Registered Nurse License * 1+ years of utilization review experience at a managed care plan or provider organization * 2 + years' clinical experience preferably in case management, rehabilitation, orthopedics, or utilization review * Excellent oral and written communication skills, including outstanding phone presence * Strong interpersonal and conflict resolution skills * Experience in a fast-paced, multi-faceted environment * The ability to set priorities and work both autonomously and as a team member * Well-developed time-management and organization skills * Excellent analytical skills * Working knowledge of: Microsoft Word, Excel, and Outlook

Where You'll Work St. Elizabeth Community Hospital provides state-of-the-art health care to the North State communities. This award-winning facility is a member of the Dignity Health system of health care providers and is a not-for-profit medical center. Located in picturesque Tehama County, St. Elizabeth offers 76 licensed beds, a trauma level III emergency department, comprehensive surgical services and a progressive Family Birth Center. St. Elizabeth Community Hospital has earned a Grade "A" from The Leapfrog Group for quality and safety for six consecutive award periods, and has built a reputation for excellence in orthopedics, family-centered maternity care and emergency services. St. Elizabeth is a sister facility to Mercy Medical Center Redding and Mercy Medical Center Mt. Shasta, and is committed to providing the highest quality, compassionate care available. For more information visit here ************************************************************************ One Community. One Mission. One California Job Summary and Responsibilities Position Summary: The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients requiring these services. The RN Care Coordinator performs this role to meet the individual's health needs while promoting quality of care, cost effective outcomes and by following hospital policies, standards of practice and Federal and State regulations. The position's emphasis will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes at the appropriate level of care. The RN Care Coordinator advocates for the patient and family by identifying, valuing, and addressing patient choice, spiritual needs, cultural, language and socioeconomic barriers to care transitions. In addition, the RN Care Coordinator strives to enhance the patient experience. P Job Requirements Minimum Qualifications: Graduate of an accredited school of nursing. Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. RN license in the state(s) covered is required. BLS required within 3 months of hiring Preferred Qualifications: Bachelor's Degree in Nursing (BSN) or related healthcare field. At least five (5) years of nursing experience. Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred Able to apply clinical guidelines to ensure progression of care. Knowledge of managed care and payer environment preferred. Must have critical thinking and problem-solving skills. Collaborate effectively with multiple stakeholders Professional communication skills. Understand how utilization management and case management programs integrate. Ability to work as a team player and assist other members of the team where needed. Thrive in a fast paced, self-directed environment. Knowledge of CMS standards and requirements. Proficient in prioritizing work and delegating where indicated. Highly organized with excellent time management skills.

Job Summary and Responsibilities osition Summary: The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients requiring these services. The RN Care Coordinator performs this role to meet the individual's health needs while promoting quality of care, cost effective outcomes and by following hospital policies, standards of practice and Federal and State regulations. The position's emphasis will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes at the appropriate level of care. The RN Care Coordinator advocates for the patient and family by identifying, valuing, and addressing patient choice, spiritual needs, cultural, language and socioeconomic barriers to care transitions. In addition, the RN Care Coordinator strives to enhance the patient experience. Job Requirements Minimum Qualifications: * Required * Graduate of an accredited school of nursing. * Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. * RN license in the state(s) covered is required. * BLS required within 3 months of hiring Preferred Qualifications: * Bachelor's Degree in Nursing (BSN) or related healthcare field. * At least five (5) years of nursing experience. * Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred * Able to apply clinical guidelines to ensure progression of care. * Knowledge of managed care and payer environment preferred. * Must have critical thinking and problem-solving skills. * Collaborate effectively with multiple stakeholders * Professional communication skills. * Understand how utilization management and case management programs integrate. * Ability to work as a team player and assist other members of the team where needed. * Thrive in a fast paced, self-directed environment. * Knowledge of CMS standards and requirements. * Proficient in prioritizing work and delegating where indicated. * Highly organized with excellent time management skills. Where You'll Work St. Elizabeth Community Hospital provides state-of-the-art health care to the North State communities. This award-winning facility is a member of the Dignity Health system of health care providers and is a not-for-profit medical center. Located in picturesque Tehama County, St. Elizabeth offers 76 licensed beds, a trauma level III emergency department, comprehensive surgical services and a progressive Family Birth Center. St. Elizabeth Community Hospital has earned a Grade 'A' from The Leapfrog Group for quality and safety for six consecutive award periods, and has built a reputation for excellence in orthopedics, family-centered maternity care and emergency services. St. Elizabeth is a sister facility to Mercy Medical Center Redding and Mercy Medical Center Mt. Shasta, and is committed to providing the highest quality, compassionate care available. For more information visit here ************************************************************************ One Community. One Mission. One California

**Become a part of our caring community and help us put health first** Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. **Preferred Locations:** Daytona, FL, Louisville, KY, San Antonio, TX **Use your skills to make an impact** **Role Essentials** + Active Unrestricted RN license + Possession of or ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work independently and within a team setting + Valid driver's license and/or dependable transportation necessary + Travel for offsite Orientation 2 to 8 weeks + Travel to offsite meetings up to 6 times a year as requested + Willing to work in multiple time zones + Strong written and verbal communication skills + Attention to detail, strong computer skills including Microsoft office products + Ability to work in fast paced environment + Ability to form positive working relationships with all internal and external customers + Available for On Call weekend/holiday rotation if needed **Role Desirables** + Education: BSN or bachelor's degree in a related field + Experience with Florida Medicaid + Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual **Additional Information** We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k with company matching, tuition reimbursement, 3 weeks paid vacation time, paid holidays, work-life balance, growth, a positive and fun culture and much more. To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 02-18-2026 **About us** About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************