Utilization review nurse jobs in Los Angeles, CA

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

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

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. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Must be located in the state of California Schedule: 9:30am-6:00pm local time, with rotating weekends. New Grads are encouraged to apply! The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. * Knowledge in Microsoft office For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $31.54/hr. - $56.77/hr. Locations: California In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. 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.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Must be located in the state of California Schedule: 9:30am-6:00pm PST, ability to work weekends if necessary. New Grads are encouraged to apply! The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. * Knowledge in Microsoft office. For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $31.54/hr - $56.77/hr Locations: California In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

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.

Job Description The PACE Utilization Review Specialist - RN oversees clinical utilization management for participants enrolled in the Program for All-Inclusive Care for the Elderly. The position ensures that services are medically appropriate, cost-effective, and coordinated. This role works closely with the PACE Medical Director and interdisciplinary team to review clinical cases, manage utilization policies, and ensure regulatory compliance. Essential Duties and Responsibilities Conduct concurrent and retrospective utilization reviews for acute, post-acute, and outpatient services. Review clinical documentation and determine appropriate levels of care based on evidence-based criteria. Manage inpatient and post-acute length of stay and coordinate timely discharge planning. Review, develop, and implement utilization management policies and workflows. Prepare and present clinical case summaries and recommendations to internal leadership. Serve as a resource for primary care providers and care managers on utilization and authorization requirements. Ensure appropriate service authorization for hospitalizations, referrals, and specialty services. Communicate with providers, payers, and internal teams regarding claim adjudication and payment status. Identify high-risk participants and coordinate with clinical leadership on care strategies. Track and report utilization metrics and trends to support program improvement. Oversee denial management processes and provider appeal reviews. Document all utilization management activities in the electronic medical record. Participate in interdisciplinary team meetings and care planning sessions. Support staff education and training on utilization management policies and standards. Minimum Qualifications Graduate of an accredited school of nursing with a current unencumbered Registered Nurse license in the State of California. Current BLS certification from the American Heart Association. Valid California driver's license and acceptable driving record. Minimum three years of managed care experience, including one year in utilization management, case management, or care coordination. Minimum one year of experience working with the frail or elderly population. Strong analytical skills with the ability to evaluate clinical documentation and apply evidence-based criteria. Knowledge of State and Federal healthcare regulations, quality standards, and utilization review principles and guidelines such as Medicare, Medicaid and MCG/InterQual. Proficient in Microsoft Office, including advanced Excel skills. Excellent communication skills, both written and verbal. Demonstrated ability to work collaboratively across multidisciplinary teams. Preferred Qualifications Bachelor of Science in Nursing (BSN) strongly preferred. Certified Case Manager (CCM) or Certified Professional in Healthcare Management (CPHM) preferred. Physical Demands and Work Environment Requires standing, walking, occasional pushing, pulling, and lifting. Ability to lift up to 30 pounds; assistance required for heavier loads. Manual dexterity and visual/hearing acuity required for clinical assessment and documentation. Exposure to infectious materials and biohazards common in healthcare settings. Must be able to communicate with participants, caregivers, and team members, including those with cognitive or physical limitations. Moderate stress related to deadlines, caseload volume, and patient conditions. Direct Reports PACE Medical Director

Job Description Assists the utilization review process taking on various tasks including data collection of demographic, claim and medical information; non-medical analysis; and outcomes reporting. Performs routine record keeping tasks. Provide clerical support to the department. Requirements High School or equivalent combination of training, education and experience. One (1) year utilization review, chart review and/or previous experience in healthcare preferred. Computer skills, data entry and filing skills. Benefits At Vista del Mar Hospital, you will find yourself in a position with great growth potential. We make it a priority to provide advancement opportunities and ongoing education for our entire team, in both clinical and non-clinical roles. This helps us ensure ongoing patient safety and quality care across our facility. Each of our professionals is compassionate and committed to the goal of excellence in the mental health care industry. Because we bring on the most reputable and experienced healthcare professionals to fill our open behavioral health jobs, our goal is to keep them long-term. This is better for patients and our own staff, as it allows everyone to feel more comfortable in their environment. Although a mental health career with Vista del Mar can be extremely rewarding in its own right, we understand the importance of employee benefits. Vista del Mar offers the following: Health Insurance Vision Insurance Dental Insurance 401K Retirement Plan Healthcare Spending Account Dependent Care Spending Account PTO Plan Discounted Cafeteria Meal Plan Life Insurance (Supplemental Life, Term and Universal plans are also available.) Short and Long-Term Disability (with additional buy-in opportunities)

About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. Additional employee paid coverage options available. We also offer paid holidays, birthday off, and unlimited PTO as well as a 401k plan. Job purpose The position of UM Nurse Reviewer reports to the Director, Case Management. The position of UM Nurse Reviewer is part of the Case Management team and is responsible for clinical, quality, and patient outcomes. This position is expected to implement the effectiveness and best practices of Utilization Review and will provide high quality medical review by appropriately applying the State, Federal, health plan and clinical guidelines used to determine medical necessity. Duties and responsibilities Review authorization requests for medical necessity, determines which requests need Medical Director review, obtains sufficient medical documentation for an informed consent. Process all requests within established time frames. Documents all steps of process in authorization system in the authorization notes. Utilizes CMS and Health Plan Hierarchy criteria. Clinical documentation, specific criteria, and record attachment for referral prior to sending to the Medical Director for review. Retrospective review of services to determine medical necessity. Refer cases to the Medical Director for review of requests that may not meet medical necessity criteria. Process denials within established timeframes. Writes denial letters to meet CMS and Health Plan requirements. Work closely with other MSO team members as necessity requires. Applies the appropriate clinical criteria/guideline, policy, EOC/benefit policy and clinical judgment to render coverage determination/recommendation for the review process. Review member's utilization and claim history when processing a referral. Maintain quality reviews while meeting the established TATs for Urgent, Routines and Retro requests. Maintains Interrater Reliability Rate at least 95% or above. Daily production standard is a minimum of 50-90 referrals/day depending on complexity with accuracy & quality. Makes approval determinations when request meets appropriateness, medical necessity and benefit criteria. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services that meet criteria and can be authorized by a nurse level reviewer. Act as clinical resource to all departments. Communicates with health plans, providers, members and other parties to facilitate member care treatment plans. Participating in team training Comply with UM policies and procedures. Annual review of UM policies. Attend to provider and interdepartmental calls in accordance with exceptional customer service. Ability to keep high level of confidence and discretion when dealing with sensitive matters relating to providers, and members. Always maintains strict confidentiality. Other duties as needed. Qualifications Valid CA and Texas/Multi State Registered Nurse license, Licensed Vocational Nurse CM and/or UM training and/or certification. Knowledge of CM standards, UM standards, Clinical Standards of Care, NCQA requirements, CMS guidelines, Milliman guidelines, and InterQual guidelines. Medi-Cal, Commercial and Medicare contracts and benefit interpretation is preferred. Five years+ clinical experience. Prefer of two (2) years+ experience in an HMO/IPA/Managed care setting is preferred and recommended. Ability to work independently with minimal supervision, exercising judgment and initiative. Ability to manage multiple tasks with effective prioritization. Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe Detail oriented and highly organized Strong ability to multi-task, project management, and work in a fast-paced environment Strong ability in problem-solving Ability to manage self-manage, strong time management skills. Ability to work in an extremely confidential environment. Strong written and verbal communication skills Education and Additional Requirements Holds Current Unrestricted CA and Texas/Multi State RN or LVN license

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who Are We? Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values. Why Join Us? We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings. Functions & Job Responsibilities * May provide any of the following in support of medical claims reviews, appeal reviews, and utilization review practices. * Completes medical necessity reviews for requested services using clinical judgment and refers cases to Medical Directors when needed * Educate providers on utilization and medical management processes * Provide clinical knowledge and act as a clinical resource to non-clinical team staff * Enter and maintain pertinent clinical information in various medical management systems * Reviews interdepartmental requests and medical information in a timely/effective manner in order to complete utilization process. * Conducts research necessary to make thorough/accurate basis for each determination made * Work on special projects related to utilization management as needed * Responds accurately and timely with appropriate documentation to members and providers on all rendered determinations * Audit case reviews to ensure compliance with utilization management policies and procedures * Assist with the development of utilization management workflows, policies, and procedures * Participates in all required training * Assist with training for new hires and continued development of existing staff * Serve as a back up to direct manager as needed * Participate in daily census review process and productivity review for staff. * Other duties as assigned

Large and traveler friendly facility in Southern California is needing help in their Case Manager Team. Must have at least 2 year of experience, and are certified BLS and CA license are needed! Call Ventura Medstaff today for more details at ************.

About TRIUNE Health Group TRIUNE Health Group is a nationally recognized managed healthcare company with over 35 years of experience. As a mission-driven, second-generation family-owned business, we are dedicated to improving lives by reducing the impact of injuries, enhancing health and wellness, and lowering healthcare and workers' compensation costs. At TRIUNE, we believe that every team member is essential to our success. We foster a supportive and collaborative environment where employees are valued, empowered, and provided with the tools they need to thrive-both professionally and personally. Why Join TRIUNE Health Group as a Nurse Case Manager? Be part of a well-established, family-owned company that prioritizes people over profits. Experience our culture of People Helping People , where every team member is treated with dignity and respect. Enjoy the stability, support, and resources needed to succeed while maintaining a healthy work-life balance. Perks & Benefits: Generous Time Off: 20 days of vacation plus 8.5 paid holidays Retirement Savings: 401(k) match to help you plan for the future Comprehensive Insurance: Medical, dental, and vision coverage Disability Coverage: Short-Term (STD) and Long-Term Disability (LTD) insurance Employee Support: Employee Assistance and Referral Program Work-from-Home Essentials: Home office equipment, including a laptop and desktop monitor Travel Perks: Mileage and travel reimbursement TRIUNE Health Group is an equal opportunity employer and a values-driven organization. Compensation is competitive and commensurate with experience. I. Summary of Position: The Nurse Case Manager coordinates resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals to facilitate quality, individualized, holistic treatment goals, including timely return to work when appropriate. II. Essential Duties and Responsibilities: Provide medical case management to individuals through coordination with the patient, physicians, other health care providers, the employer, and the referral source. Utilize the steps of Case Management to provide assessment, planning, implementation, evaluation, and outcome of an individual's progress. Evaluate individual treatment plans for appropriateness, medical necessity, and cost-effectiveness. Facilitate care, such as negotiating and coordinating the delivery of durable medical equipment and home health services, ensuring clear communication. Assess rehabilitation facilities for appropriateness of care, facilitate transportation, and coordinate architectural assessments of patients' homes when required. Communicate medical information clearly and compassionately to patients and families. Stay current with medical terminology and the federal and state laws related to health care, Workers' Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and SSA. Utilize technology (computer, cell phone, fax, and scanning machine) to prepare organized, timely reports while complying with safety rules and regulations in conjunction with HIPAA. Research medical and community resources for individuals with catastrophic or chronic diagnoses, such as but not limited to AIDS, cancer, spinal cord injuries, diabetes, head injuries, back injuries, hand injuries, and burns, ensuring accessibility for individuals. Possess a valid driver's license with the ability to travel 90% of the time. Perform other duties as assigned. III. Job Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Skills and Abilities: Proven leadership skills. Excellent verbal and written communication skills, including the ability to interact effectively with patients, customers, and fellow employees via phone, email, in-person, and formal presentations. Methodical in accomplishing job-related goals. Strong analytical and organizational skills, including the ability to multitask with attention to detail. In-depth knowledge of multi-software packages, notably Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and the Internet. Maintain a friendly, professional attitude at all times. Exercise initiative and be solution-oriented, while keeping management up-to-date on current situations or opportunities. Dependability and adaptability. Education and Experience: Graduate of an accredited school of nursing. Current RN licensure in the state of operation. Fluency in English (speaking, reading, and writing). Three or more years of recent clinical experience, preferably in trauma, psychology, emergency, orthopedics, rehabilitation, occupational health, and neurology. CCM preferred. Certificates, Licenses, Registrations: While not mandatory, individuals with one or a combination of the following certifications are preferred: COHN, COHN-S, and CDMS. IV. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The base salary range/hourly rate listed is dependent on job-related, non-discriminatory factors such as experience, education, and skills. This position is also eligible for incentive compensation awards. You may be eligible for the following competitive benefits: medical, dental, vision, life, accident & disability, short and long-term disability, paid holidays, paid time off and 401 (k). bination of the following certifications is preferred: COHN, COHN-S, CCM, and CDMS.

High Desert Medical Group is seeking a full time Utilization Management Nurse Reviewer. This employee will evaluate the appropriateness of healthcare services, ensuring patients receive necessary care while managing resources effectively. They will examine medical treatments and interventions to ensure they are necessary and effective, conducting audits and reviews. Summary of Duties: Understand, promote, and audit the principles of Utilization Management (UM) to facilitate the right care at the right time in the right setting. Be familiar with UM requirements of NCQA and the health plans and implement them accordingly. Be familiar with the contractual arrangements of the organization to provide steerage to the appropriate settings and providers. Identify trends or issues in the UM processes that require further evaluation for their quality or utilization implications and bring these items to the attention of the UM Physician/Medical Management Administrator/Administrator. Communicate effectively and interact with the provider group, staff and health plans daily or as indicated regarding UM and referral authorization issues. Review and analyze organized UM logs and other related information. Participate in monthly UM meetings to disseminate new information. Assist the UM Physician with communications, training, meetings, protocol, etc. Verify that the process in place for collecting data for referrals is followed via regular audits of the staff's production. Verify that the process in place for applying medical necessity criteria is followed via regular audits of the referral process. Verify that the denial process in place is followed and compliant via regular review of the denial letters. Perform other duties as assigned. The pay range for this position at commencement of employment is expected to be between $29.00 - $39.93/hr, non-exempt; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment. If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

The Senior Utility Coordinator is responsible for coordinating the relocation of existing utilities or clearing any potential conflicts for the delivery of infrastructure projects for various clients on transit, municipal, highway, and airport projects. This opportunity entails working with project design teams to coordinate the relocation of existing utilities in advance of construction projects. The Sr. Utility Coordinator should be well-versed in relocation strategies and the laws and regulations of the relevant jurisdictions. Furthermore, the Sr. Utility Coordinator should have the ability to understand the technical aspects of projects. The Senior Utility Coordinator's job is to ensure any important information is properly communicated to each party, whether through utility conflict matrices, reports of investigation, right-of-way data sheets, schedule updates, as-builts, maps, or design plans. Responsibilities Coordinates with the internal project team, client, and utility companies. Lead or facilitate meetings involving utility-specific activities Assists in the implementation of utility coordination for projects including, but not limited to, desktop investigation, subsurface utility investigation, resolution of utility conflicts, the management of documentation as required by the client, and utility clearance that is in conformance with agency/state/federal regulations and industry standards. Coordinate and track utility submittals and responses Review Design plans and prepare utility conflict analysis Prepare and review cost estimates, schedules, prior rights determinations, and agreements for relocation Identifies conceptual relocations and permanent and temporary easements for relocation, as applicable. Assists with preparing and packaging utility construction permits for submission to municipal and state agencies, including Notice to Owners (NTO) and Utility Agreements (UA), as appropriate. Perform technical discipline tasks, including research, design reviews, and specification preparation. Performs other duties as assigned. Qualifications 10+ years' experience performing Utility Coordination Knowledge of relocation strategies and the laws and regulations of the relevant utility companies and local jurisdictions. Ability to understand the technical aspects of projects Wet and dry utility relocation, design, and/or construction experience Knowledge of right-of-way Proficient using Microsoft Office (Word, Excel, Outlook Software) Interpersonal and client-facing responsibilities include excellent, clear, and concise oral and written communication skills and a demonstrated ability to coordinate meetings and resources Ability to collaborate on multi-discipline projects/teams Preferred Qualifications Bachelor's degree or equivalent CA Licensed P.E. 15+ years of experience performing similar work Ability to plot existing utilities in 2D and 3D in MicroStation, AutoCAD, and similar platforms; or provide direction doing so. Salary Range: $125,000 - $185,000 Location: Los Angeles, CA Work Environment: Onsite Our Company Cordoba Corporation, Making a Difference Cordoba Corporation is a leading civil engineering, construction management, program management, and planning firm. Our expertise spans diverse sectors, including education and facilities, transportation, water, and energy. Collaborating closely with our clients, we have successfully delivered complex, high-impact infrastructure projects across California. National Recognition - Cordoba's efforts have garnered national acclaim. Engineering News-Record (ENR) has consistently ranked us as a “top 100 construction management firm” and a “top 50 program management firm.” Additionally, ENR recognized Cordoba as a “top 100 design firm” in California in 2018. Our business model emphasizes efficiency, fostering a dynamic work environment. We approach projects with multifaceted strategies, ensuring successful outcomes. Statewide Presence - With headquarters in Los Angeles, Cordoba maintains a strong statewide presence. Our offices extend to San Francisco, Sacramento, San Ramon, Chatsworth, Santa Ana, Ontario, and San Diego. Enhancing Employee Well-Being Benefits and Perks: We offer multiple medical, dental, and vision insurance plans. Plans are subsidized for employees and dependents with coverage effective the first month after hire. Additionally, Cordoba provides employees with paid AD&D and life insurance, a 401k with an industry-leading employer match, generous vacation and sick leave accruals, nine paid holidays, and other forms of paid time off. We also offer flexible spending accounts (FSAs), including medical care reimbursement, dependent care reimbursement, and commuter benefit plans. Employees are also eligible for our employee assistance program and well-being benefits, including stress management, nutrition, and financial well-being. Cordoba Corporation provides equal employment opportunities, promoting diversity and inclusion. We welcome applicants regardless of race, color, religion, sex, national origin, age, disability, or genetics. Harassment-Free Workplace: We strictly prohibit workplace harassment based on any factor, including race, gender, sexual orientation, or disability. Cordoba is committed to fostering a healthy and happy lifestyle for our employees within and beyond the workplace. Please contact our HR Department at ************** for inquiries or accommodations. Join Cordoba Corporation and be part of shaping California's future!

Job DescriptionBenefits: 401(k) matching Dental insurance Employee discounts Free uniforms Health insurance Paid time off Training & development Vision insurance If you like to innovate, are self-reliant with a strategic mind and forward-thinking solutions approach and interested in giving your full potential and grow with us, this position may be for you. We are a social and environmental responsible Company. Our commitment to quality, continuous improvement, safety, community, belonging and adaptability are part of our personality. We are looking for a proactive, independent and highly qualified Third Party Coordinator who can lead all design and construction activities and interact with third-party agencies that hold Authority Having Jurisdiction (AHJs) over LAWA, assisting the Third-Party Lead in facilitating their efforts. Essential Job Duties Assist the Third-Party Lead in coordinating with city, county, state agencies, and utilities. Represent the City when interacting with private engineers, contractors, governmental agencies, and the public. Manage activities between developers/contractors and third parties. Assist the Third-Party Lead in developing reporting mechanisms to track third-party progress. Provide progress updates on efforts in coordinating third-party activities. Attend and participate in third-party progress meetings at various locations virtually, at Project Management Offices, in the field, or at the third-party offices (several are in downtown Los Angeles). Prepare meeting agendas, minutes, and action items. Track action items to completion as they relate to third parties. Act as a utility coordinator between utility companies, contractors, and the LAWA. Attend utility design, engineering, and construction coordination meetings, as needed, and provide insight regarding stakeholder requirements and ensure compliance. Act as a liaison between squads, sections, divisions, and departments. Support and advise project teams, particularly regarding coordinating logistics and interfaces with third parties. Support Third Party Lead and Logistics and Interface Managers in other efforts, as required. Prepare and review technical reports and written correspondence. Review general project requirements, design criteria, and contract requirements. Ensure that monthly reports describing activities associated with Third Party Coordination are prepared and forwarded to the project management team. Develop presentations describing third-party updates, including key accomplishments, ongoing coordination activities, and issues for project management teams. Participate in negotiations with regulatory agencies and in public meetings in support of LAWA Contribute to advancing LAWAs goals through commitment to productive collaboration with all stakeholders. Safety principles and practices Hardware/Software Knowledge Proficiency with Microsoft systems, including Outlook, Excel, Word, PowerPoint, OneNote, Teams, SharePoint, Prolog or other similar PMIS, Adobe Acrobat or Bluebeam Revu, Familiarity with Primavera P6 or other Scheduling Software. Familiarity with MicroStation and/or Autodesk systems, including AutoCAD, Revit, Civil 3D, and BIM 360. Professional Experience Level/Other Qualifications 10 years or more experience with third party coordination in Los Angeles. Local experience with agencies such as the City and County of Los Angeles, CPUC, Caltrans, Metro, or City of Inglewood. Familiarity with industry practices, codes, and regulations. Thorough understanding of airport-specific enterprise-wide challenges and inherent communications needs. Excellent written and verbal communication, organizational, and interpersonal skills are required. Be familiar with the Department of Public Works and LADBS permitting processes. Education/Training Bachelors degree in Engineering, Project Management, Business , or other related technical field. A Masters degree is preferred. Element-Specific Requirements/Notes May assume other duties as required/needed May be required to work various shifts as needed May be required to travel to the field and PMOs This position offers a hybrid/telework schedule. Telework - Monday and Friday. Onsite - Tuesday, Wednesday and Thursday. Please refer to LAWAs Pilot Policy for details Registration/Certification Optional Certifications may include AAAE, LEED, PMP, PE, AICP, PMI-SP etc. or any other relevant Professional Licensure or Certifications. Registration as a Professional Engineer with the California State Board of Registration for Professional Engineers is preferred.

The Utilities Coordinator III/VDC is responsible for: o Monitoring and reconciling the design, construction, and facilities submittal data related to underground utilities o Collection and QA/QC of CMMS Data for impacted facilities and infrastructure. This may include, but is not limited to, the following activities: o Review and upload equipment data from completed As-Builts to CMMS. o Review and upload GIS spatial data (building spaces, hardscape/softscape, landscape, infrastructure, and security features) to CMMS. • Managing and maintaining as-built information related to Bond impacted projects. This may include, but is not limited to, researching data or documents in SharePoint, DocView or another accessible data source, to produce files or reports such as: o CAD/BIM As-Built drawings. o Underground utilities CAD database • Compliance review. o Utility Infrastructure (ASCE 38-02 and Underground Utility Standard compliance) o Spatial Reports, demonstrated in plans or tabular format. • Supporting As-Built/M&O data delivery review at Ops Closeout for current projects. This may include, but is not limited to, the following activities: o Local Projects (Infrastructure, security, energy, stormwater) o Develop record utility maps of impacted facilities and infrastructure. • SharePoint record drawings database Support Provide BIM Submittal tracking o Reviewing underground utilities submittals for conformance standards o BIM submittal coordination between project teams and design/construction teams. • Work with teams to develop BIM and GIS scope of services as requested. • Provide support as requested to BIM team with Revit, AutoCAD, SharePoint, Document Control, ESRI and closeout. • Review utilities and BIM deliverables for ArcGIS online utility infrastructure integration. • Site walks and spot checking of project sites. Including but not limited to LIDAR scanning, GPR surveying, GPS surveying and photography • Travel to all project sites to provide QAQC and field collection Minimum Required Qualifications: Minimum 5 years' recent experience in working in Architecture or Construction Management, with a specific focus on utilities Bachelor's degree in Architecture, Engineering, or closely related degree. Additional qualifying experience in excess to the minimum states above may be substituted for the required education on a year for year basis. Advanced geographic information systems concepts, principles, practices and techniques, including computer mapping and attribute conversions, transfer, manipulation and analysis. Experience knowledge to perform modeling and coordination task within AutoCAD, Revit and Map 3D Experience knowledge to perform data management task within SharePoint, BIM 360 Docs and Bluebeam. Experience with LIDAR scanning, GPR surveying, GPS surveying and photography. Preferred Qualifications: Experience working with Design and Construction Teams. Strong knowledge of BIM and Utility Infrastructure workflows. Experience knowledge to perform field survey data collection and coordination tasks within AutoCAD, Revit, Civil 3D, AutoCAD Map 3D, ArcGIS Data Collector. Strong experience with Autodesk tools and applications. Job Posted by ApplicantPro

The Senior Utility Coordinator is responsible for coordinating the relocation of existing utilities or clearing any potential conflicts for the delivery of infrastructure projects for various clients on transit, municipal, highway, and airport projects. This opportunity entails working with project design teams to coordinate the relocation of existing utilities in advance of construction projects. The Sr. Utility Coordinator should be well-versed in relocation strategies and the laws and regulations of the relevant jurisdictions. Furthermore, the Sr. Utility Coordinator should have the ability to understand the technical aspects of projects. The Senior Utility Coordinator's job is to ensure any important information is properly communicated to each party, whether through utility conflict matrices, reports of investigation, right-of-way data sheets, schedule updates, as-builts, maps, or design plans. Responsibilities Coordinates with the internal project team, client, and utility companies. Lead or facilitate meetings involving utility-specific activities Assists in the implementation of utility coordination for projects including, but not limited to, desktop investigation, subsurface utility investigation, resolution of utility conflicts, the management of documentation as required by the client, and utility clearance that is in conformance with agency/state/federal regulations and industry standards. Coordinate and track utility submittals and responses Review Design plans and prepare utility conflict analysis Prepare and review cost estimates, schedules, prior rights determinations, and agreements for relocation Identifies conceptual relocations and permanent and temporary easements for relocation, as applicable. Assists with preparing and packaging utility construction permits for submission to municipal and state agencies, including Notice to Owners (NTO) and Utility Agreements (UA), as appropriate. Perform technical discipline tasks, including research, design reviews, and specification preparation. Performs other duties as assigned. Qualifications 10+ years' experience performing Utility Coordination Knowledge of relocation strategies and the laws and regulations of the relevant utility companies and local jurisdictions. Ability to understand the technical aspects of projects Wet and dry utility relocation, design, and/or construction experience Knowledge of right-of-way Proficient using Microsoft Office (Word, Excel, Outlook Software) Interpersonal and client-facing responsibilities include excellent, clear, and concise oral and written communication skills and a demonstrated ability to coordinate meetings and resources Ability to collaborate on multi-discipline projects/teams Preferred Qualifications Bachelor's degree or equivalent CA Licensed P.E. 15+ years of experience performing similar work Ability to plot existing utilities in 2D and 3D in MicroStation, AutoCAD, and similar platforms; or provide direction doing so. Salary Range: $125,000 - $185,000 Location: Los Angeles, CA Work Environment: Onsite Our Company Cordoba Corporation, Making a Difference Cordoba Corporation is a leading civil engineering, construction management, program management, and planning firm. Our expertise spans diverse sectors, including education and facilities, transportation, water, and energy. Collaborating closely with our clients, we have successfully delivered complex, high-impact infrastructure projects across California. National Recognition - Cordoba's efforts have garnered national acclaim. Engineering News-Record (ENR) has consistently ranked us as a “top 100 construction management firm” and a “top 50 program management firm.” Additionally, ENR recognized Cordoba as a “top 100 design firm” in California in 2018. Our business model emphasizes efficiency, fostering a dynamic work environment. We approach projects with multifaceted strategies, ensuring successful outcomes. Statewide Presence - With headquarters in Los Angeles, Cordoba maintains a strong statewide presence. Our offices extend to San Francisco, Sacramento, San Ramon, Chatsworth, Santa Ana, Ontario, and San Diego. Enhancing Employee Well-Being Benefits and Perks: We offer multiple medical, dental, and vision insurance plans. Plans are subsidized for employees and dependents with coverage effective the first month after hire. Additionally, Cordoba provides employees with paid AD&D and life insurance, a 401k with an industry-leading employer match, generous vacation and sick leave accruals, nine paid holidays, and other forms of paid time off. We also offer flexible spending accounts (FSAs), including medical care reimbursement, dependent care reimbursement, and commuter benefit plans. Employees are also eligible for our employee assistance program and well-being benefits, including stress management, nutrition, and financial well-being. Cordoba Corporation provides equal employment opportunities, promoting diversity and inclusion. We welcome applicants regardless of race, color, religion, sex, national origin, age, disability, or genetics. Harassment-Free Workplace: We strictly prohibit workplace harassment based on any factor, including race, gender, sexual orientation, or disability. Cordoba is committed to fostering a healthy and happy lifestyle for our employees within and beyond the workplace. Please contact our HR Department at ************** for inquiries or accommodations. Join Cordoba Corporation and be part of shaping California's future!

Prior Authorization Temp Nurse Case Manager, RN Northridge, CA 4-Month Contract Assignment Quick On-Boarding/Placement Process Career Stepping Stone from Bedside Nursing to Case Management (acute care experience and working knowledge of pre-auth process required) Description The role of the Prior Authorization Nurse Case Manager (PACM) is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization specialty referral requests. The PACM will review for appropriate care and setting, and following guidelines/policies, will approve services when indicated. If not indicated, PACM will forward requests to the appropriate physician or medical director with recommendations for other determinations, ensuring that the member is receiving the appropriate quality care in a preferred setting, while making sure regulatory guidelines are followed. 1. Understand, promote and review with the principles of medical management to facilitate the right care at the right time in the right setting. 2. Communicate effectively and interact with providers, staff and health plans daily regarding medical management and referral authorization issues. 3. Maintain a working relationship with PACM colleagues, the pre-auth coordinator team, high-risk nurse case managers, inpatient nurse case managers, medical directors, and network management. 4. Research alternative care plans and when necessary, assist in the routing of members to the most appropriate care/setting, in order to provide right care/right setting. 5. When necessary, act as liaison between the case managers, UM coordinators, contracted providers (PCPs/specialists/ancillary), and the members/families. 6. Perform case reviews base on key screening outpatient indicators, and evaluate the PCP submitted plan of care for its completeness of documentation, consistency of treatment with medical groups clinical practice guidelines, adherence to standard evidence-based or consensus guidelines, and health plan and CMS guidelines and/or medical policies. 7. Maintain regulatory Turnaround Time Standards per regulatory guidelines. 8. Document accurately and completely all necessary information in authorization notes. 9. Understand all applicable capitation contracts and how they apply to review duties. 10. For those PACMs involved in DME, understand the contracts, and need to review rental vs. purchase approvals, and continued use so that equipment is picked up when needed. 11. When appropriate, coordinate and review for medical necessity and appropriate utilization any ancillary professional services, i.e. (home health, infusion, PT, OT, ST, etc.). 12. Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner. 13. Participates in “service recovery” through follow-up with an upset patient or provider, gathering information, and demonstrating empathy. 14. Identifies network needs and report to management for potential contracting opportunities. Qualifications 1.Graduate from an accredited Registered Nursing Program 2.Current California RN License 3.Minimum of 1 year acute experience 4.Knowledge of Managed Care preferred. 5.Knowledge of NCQA, CMS, HSAG, and health plan requirements related to utilization management. 6.Knowledgeable with the pre-authorization process and workflow, with prior authorization experience preferred. 7.Knowledgeable in computers and MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point). 8.Ability to deal with responsibility with confidential matters 9.Ability to work in a multi-tasking, fast-paced, high-stress environment. Compensation $38-$42/Hr Negotiable based on experience

*5 years WC Examiner experience *Medical understanding to find treatment plans *Must be available continually during disgnated work hours *Abliity to follow pre-established medical protocols *Strong verbal and written communication skills *Eastside of WA (Ideally, tri-cities) *Relational personality is a must *Bilingual (Spanish) is a plus *Manage nurses and staff clients accordingly Salary will be discussed during interview *Bonus *Excellent pay *Excellent benefits

Be Part of an Extraordinary Team A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting. Title: Clinical Nurse Liaison- Paragon Ideal candidates will reside in Alaska and comfortable traveling 50% of the time between Alaska, Washington, Oregon, and California Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. 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. Build the Possibilities. Make an Extraordinary Impact. The Clinical Nurse Liaison- Paragon is responsible to provide patient education and continuing education programs, as well as problem solves and resolves questions and issues for referral sources and patient. How you will make an impact: Primary duties may include, but are not limited to: Determines clinical and service needs for established and new accounts and referrals. Effectively communicates with the referral source, branch, physician, and family to coordinate and facilitate plan of care for patients. Markets all therapies, services, and products to referral sources. Provides in-services and continuing education programs for hospital case managers and other referral sources and support staff. Identifies and pulls through appropriate specialty infusion referrals and assists in maximizing revenue within local / regional market. Partners with leadership team to communicates opportunities for relationship building and business expansion. Minimum Requirements: Requires a minimum of 3 years of expansive work experience in a clinical environment; or any combination of education and experience which would provide an equivalent background. Licensed Registered Nurse required. Preferred Skills, Capabilities and Experiences: Bachelor's degree preferred. Strongly prefer experience in the home care setting. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $78,016 to $117,024 Locations: California, Washington State 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 Exempt Workshift: Job Family: SLS > Sales - Field 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.