Utilization review nurse jobs in Lakewood, CA - 278 jobs

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

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

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

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

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

Job Description Seeking a Quality Management Nurse who will be responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards and regulations. This role involves evaluation clinical practices, identifying areas for improvement, and implementing quality improvement initiatives to enhance patient care and safety. In this role, you will support all Medical Group Health Education & Disease Management Programs utilizing established interventions, performing necessary surveys acting as the primary liaison between providers and office staff and Health Plans to facilitate appropriate Health Education opportunities. Additionally, you will perform HEDIS related activities, Pay for Performance activities, Provider Access and Availability Surveys (PAAS), investigates and resolves access-related patient issues, and develops QI reports and action plans, as necessary. Must reside local to Los Angeles, CA. Work Hours: Monday Friday, 8:00am 5:00pm PST Work Location: Occasional travel to various healthcare clinics/facilities within assigned geographic region Duration: Indefinite Salary Range: $37.68 - 78.35 Hourly Key responsibilities include: Travel to various clinic sites and schedule and conduct medical record and facility site audits Conduct thorough facility site reviews and medical record audits, including inspections of clinical areas, patient care practices, and administrative processes Review medical records of services in preparation for health plan and/or regulatory audits for medical appropriateness by using established clinical protocols and health plan resource tools Assess compliance with healthcare regulations, accreditation standards, and organizational policies Extrapolate and prepare a detailed, organized analysis of the essential information gathered to address facility site reviews and medical record audits Prepare detailed reports on findings from site reviews and present recommendations to management Identify areas for improvement and develop action plans to address deficiencies. Develop corrective action plans as needed conducting appropriate follow up and provide related reports Collaborate with healthcare providers and administrative staff to implement quality improvement initiatives Provide education and training to internal staff on quality management practices and regulatory requirements Assist in QM Department projects including but not limited to HEDIS/Pay for Performance, clinical studies and access surveys producing charts, graphs, and reports to demonstrate results and outcomes Initiate and maintain QM activities required for the credentialing and re-credentialing process Attend and participate in QM meetings preparing agendas, materials, minutes, and action follow-ups in a timely manner Qualifications Current LVN or RN licensure in the state of California. If providing RN licensure, a BSN or MSN is required Three years or more of clinical nursing experience with at least 2 years in a quality management role What is in it for you? Health, Dental, Vision Insurance Health Savings Account (FSA) Flexible Schedule Disability & Life Insurance Paid Time Off Professional Development Assistance Referral Program Retirement Plan Tuition Assisstance Home & Family Benefits (Adoption Assistance, Legal, Pets, Auto & Home, Legal, etc.) Apply today!

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.

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 ************** **************************

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

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

DescriptionAstrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This position requires open availability between Monday through Sunday, 8 A - 8 P. You would be scheduled for 5 shifts per week. This is a hybrid position where you will work at-home and in our Monterey Park office on a weekly basis. We are open to nurses without prior UM experience! Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team What You'll Do Complete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment Refer cases to Medical Directors as needed/appropriate Maintain knowledge of state and federal regulations and accreditation standards Comply with internal policies and procedures Perform any other job duties as requested Qualifications Active and unrestricted LVN CA license. Experience with Microsoft applications such as Word, Excel, and Outlook You'll be Great for this Role If: Two (2) years of health plan, IPA or MSO experience Strong interpersonal skills Ability to collaborate with co-workers, senior leadership, and other management Experience educating and training staff Environmental Job Requirements and Working Conditions This is a hybrid position, where you will work at home and in-office on a weekly basis. Typical business hours are Monday - Friday from 8:30 AM to 5 PM, however, this position requires open availability between 8 AM - 8 PM PST, M-Su. Your schedule will be compromised of 5 shifts per week. Nurses rotate weekend and holiday coverage. Overtime is required in this position. The national target pay range for this role is $30.00 - $34.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at ************************************ to request an accommodation. Additional Information:The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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

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

EXAM NUMBER Y5125L TYPE OF RECRUITMENT We welcome applications from anyone! FILLING DATE The application filing period will begin on May 22, 2025, at 9:00 a.m. (PT) - Continuous. We will keep accepting applications until the position is filled. The application window may close unexpectedly once we have enough qualified candidates. Why Join the LA County Department of Health Services? The Los Angeles County Department of Health Services (DHS) is more than just a healthcare provider - we're a cornerstone of our community's health. As the second largest municipal health system in the nation, DHS operates an integrated network of 25 health centers and four hospitals, alongside an expanded network of community partner clinics. Every year, we deliver compassionate, life-saving care to over 600,000 unique patients across LA County. With more than 23,000 dedicated staff members and an annual budget exceeding $6.9 billion, DHS is dedicated to transforming healthcare and creating lasting change in our community. For additional information regarding DHS please visit www. dhs.lacounty.gov Check Out Our Outstanding Benefits! We offer one of the strongest public-sector benefits packages in the country. Join us and discover a rich selection of health care options, robust retirement plans and the flexibility to work, relax and rejuvenate as you reach your fullest personal and professional potential. Click here to see comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're working in community clinics or hospitals, this is your opportunity to grow your career while serving diverse communities across LA County. Definition: Provides technical and administrative direction to staff performing reviews of patients' medical charts to ascertain the medical necessity for services and the appropriateness of the level of care.What You'll Be Doing: * Plans, directs, assigns, and evaluates the work of subordinates engaged in utilization review activities. * Plans, develops, and implements procedures to fulfill the requirements and guidelines for an effective and timely utilization review system. * 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. * 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. * Works with Professional Standards Review Organization representative to orient new staff to Federal laws and regulations pertaining to Medicare and Medi-Cal reimbursement. * Analyzes cases for referral to the physician advisor to ensure that the admission or continued stay is being questioned based upon appropriate screening criteria and standards; serves as the liaison with the physician advisor for the referral of unusual questionable cases, on referred cases for reconsideration, and to obtain authorization for the issuance of denial letters. * Reviews, retrospectively, utilization review records for completeness, use of appropriate codes, correctness of primary reason for admission and certified hospital days, and inclusion of all relevant supporting medical information. * Develops procedures for the compilation of information from medical charts concerning particular diagnoses, problems, procedures, or practitioner categories as directed for medical care evaluation studies. * Prepares and analyzes reports 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. * 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, as needed. * As a unit supervisor at the LA General Medical Center: * Has immediate responsibility for organizing, assigning, and evaluating the work of at least seven Utilization Review Nurses. * Acts as a technical resource person to subordinate staff concerning Federal regulations pertaining to Medicare and Medi-Cal reimbursement, aspects of medical treatment for unusual illnesses and diseases, and interpretation of review procedures and standards. * Participates in the formulation of and changes in utilization review procedures by assessing the effectiveness of the review system and providing information on the policies and procedures within the assigned medical areas. * Provides input for the in-service training program by identifying areas of deficiency in staff knowledge or experience. * Analyzes cases for referral to the physician advisor to ensure that the admission or continued stay is being questioned based upon appropriate screening criteria and standards; serves as the liaison with the physician advisor for follow up on referrals. * Reviews, retrospectively, Utilization Review Records for completeness, use of appropriate codes, correctness of primary reason for admission and certified hospital days, and inclusion of all relevant supporting medical information. * Compiles data on number and status of reviews, physician advisor referrals, and type of physician advisor determinations. * Maintains effective working relationships with unit physicians to facilitate the execution of the utilization review system. * Participates in the work performed by subordinates. SELECTION REQUIREMENTS: OPTION I: One year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS. * OR- OPTION II: Two (2) years of experience as a registered nurse, of which one year must be in the treatment of chronic and short- term medical and surgical inpatient problems, AND one (1) year of experience in the first-level supervision* of registered nurses and other nursing staff. LICENSE REQUIREMENT INFORMATION: * A current, active license to practice as a Registered Nurse issued by the California Board of Registered Nursing. * A current Basic Life Support (BLS) for Healthcare Providers (CPR & AED) Program certification issued by the American Heart Association. Applicants must ensure the Certificates and Licenses Section of the application is completed. Provide the title(s) of your required certification(s) and/or license(s), the number(s), date(s) of issue, date(s) of expiration, and the name(s) of the issuing agency for the required certification(s) and license(s) specified above. Required certificates and licenses has to be active and unrestricted, or your application will not be accepted. Applicants must attach a legible copy/image of required and/or desired certifications and licenses to their application at the time of filing, or email the document/s to the exam analyst to aharraway@dhs.lacounty,gov within seven (7) calendar days from the application date. Applications submitted without the required certificates and/or licenses will be rejected. Applicants claiming experience in a state other than California have to 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. PHYSICAL CLASS: Physical Class II - Light: This class includes administrative and clerical positions requiring light physical effort that may include occasional light lifting to a 10-pound limit and some bending, stooping, or squatting. Considerable ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that the care provided to patients are appropriate and covered by the insurance payer. They are responsible for ensuring that patient services are cost-effective, and their stay is at the appropriate level of care and length of stay. In the County of Los Angeles, a Medical Service Coordinator, CCS determines medical eligibility of children referred to California Children Services and approves and coordinates treatment services for children accepted under the program. * For this examination, supervision MUST include all the following: planning, assigning, reviewing work of staff and formally evaluating employee performance. To receive credit for your education, include a copy of your official diploma, official transcript, or letter/certificate from an accredited institution with your application at the time of filing or within seven (7) calendar days of filing your application. The document should show the date the degree was conferred and be in English; if it is in a foreign language, it must be translated and evaluated for equivalency to U.S. standards. For more information on our standards for educational documents, please visit:***************************************************************** PDF reader)and ************************************************************************************* PDF reader). Please submit documentation to ************************** and indicate your name, the exam name, and the exam number. We do not accept password-protected documents. Ensure documents are unlocked before attaching to your application or sending to the exam analyst. DESIRABLE QUALIFICATIONS: Additional credit will be given to applicants who possess the following desirable qualifications in excess of the Selection Requirements: * A Bachelor's Degree in Nursing or higher from an accredited institution. * Additional experience of first-level supervision* of registered nurses and other nursing staff in excess of the selection requirements. EXAMINATION CONTENT: This exam will consist of an evaluation of experience based upon application information, supplemental questionnaire, and desirable qualifications weighted 100%. CANDIDATES ACHIEVING A PASSING SCORE OF 70% OR HIGHER WILL BE ADDED TO THE ELIGIBLE REGISTER. ELIGIBILITY INFORMATION: We process applications as we receive them. If you pass the assessment, we will place you on a list for 12 months. The hiring managers within DHS will use this list to fill vacancies as they become available. Applicants who are successful in this examination and are added to the eligible register may not apply for and compete in this examination for twelve (12) months following the date of being placed on the eligible register. Applications received before expiration from the eligible register will be rejected. Applicants who have applied and did not meet the Requirements at the time of filing may reapply 30 days from their latest application date. VACANCY INFORMATION: The eligible register resulting from this examination will be used to fill vacancies throughout Los Angeles County as they occur. AVAILABLE SHIFTS: You may be required to work evenings, nights, weekends, and holidays, depending on operational needs. APPLICATION AND FILING INFORMATION: We only accept applications filed online. Applications submitted by U.S. mail, fax, or in person are not accepted. Apply online by clicking on the "Apply" green button at the top right of this posting. This website can also be used to get application status updates. New email addresses need to be verified. This only needs to be done once per email address and can be done at any time by logging in to govermentjobs.com and following the prompts. This is to enhance the security of the online application and to prevent incorrectly entered email addresses. Please fill out the application completely. Provide relevant job experience including employer's name and address, job title, beginning and ending dates, number of hours worked per week, and description of work performed. We may verify information included in the application at any point during the examination and hiring process, including after an appointment has been made. Falsification of information could result in refusal of application or rescission of appointment. Copying verbiage from the Requirements or class specification as your work experience will not be sufficient to demonstrate meeting the requirements. Doing so may result in an incomplete application and may lead to disqualification. We will send notifications to the email address provided on the application, so it is important that you provide a valid email address. If you choose to unsubscribe or opt out from receiving our emails, it is possible to view notices by logging into governmentjobs.com and checking the profile inbox. It is every applicant's responsibility to take steps to view correspondence, and we will not consider claims for missing notices to be a valid reason for re-scheduling an exam part. Register the below domains as approved senders to prevent email notifications from being filtered as spam/junk mail. ************************** noreply@governmentjobs.com *********************** Social Security Number: Federal law requires that all employed persons have a Social Security Number, so include yours when applying. Computer and Internet Access at Public Libraries: For candidates who may not have regular access to a computer or the internet, applications can be completed on computers at public libraries throughout Los Angeles County. No Sharing of User ID, E-mail and Password: All applicants must file their application 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. Anti-Racism, Diversity, and Inclusion (ARDI): The County of Los Angeles recognizes and affirms that all people are created equal and are entitled to all rights afforded by the Constitution of the United States. The Department of Human Resources is committed to promoting Anti-racism, Diversity, and Inclusion efforts to address the inequalities and disparities amongst races. We support the ARDI Strategic Plan and its goals by improving equality, diversity, and inclusion in recruitment, selection, and employment practices. * For any inquiries about the position or assistance with the application process, please contact Alvonte Harraway at **************************. Alvonte is here to guide you every step of the way. * Department Contact Phone: ************** * Teletype Phone: ************** * California Relay Services Phone: ************** * For Accommodation requests, please contact our Accommodation Coordinator, via ************** * Please reference Exam Number: Y5125L in all communications during the application process.

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

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

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

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

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