Registered Nurse - Utilization Management
myPlace Health
Job Description
Job Description
About the Role
Join myPlace Health as a Registered Nurse - Utilization Management in Los Angeles, CA. myPlace Health specializes in providing value-based, comprehensive care and coverage for older adults with significant needs, enabling them to thrive in their homes. In this full-time role, you will play a crucial part in ensuring participants receive appropriate and efficient care through our myPlace PACE model, which provides seamless primary care, integrated health plan coverage, and personalized social engagement.
Key Responsibilities- Conduct utilization reviews for medical services to ensure alignment with established guidelines and participant care plans.
- Assess the medical necessity of admissions, continued stays, and ancillary services.
- Collaborate with interdisciplinary teams, including physicians, social workers, and other healthcare professionals, to optimize participant outcomes.
- Document all review activities accurately and thoroughly in accordance with regulatory standards and myPlace Health policies.
- Identify trends and opportunities for improvement in care delivery and resource utilization.
- Provide comprehensive reports on utilization management activities and outcomes.
- Participate in ongoing training and professional development to maintain expertise in utilization management.
Required:
- 3 years of experience as a Registered Nurse.
Preferred:
- None specified
- Health insurance
- Paid time off (PTO)
- 401(k) match
- Dental insurance
- Paid holidays
- Vision insurance
- 401(k)
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Registered Nurse - Utilization Management in Los Angeles, CA vacancy
$60 - $75 per hour
...Utilization Management Nurse We 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...SuggestedHourly payWork at officeFlexible hoursPresidential Staffing Solutions LLC
Los Angeles, CA5 days ago- ...Job Description Job Description Job Description: Manager of Clinical Utilization Management - Denial Compliance Location: Burbank, CA... ...Qualifications: 1. Graduate from an accredited Registered Nursing Program; RN preferred. 2. Minimum of five years in...SuggestedPermanent employmentFull timeTemporary workRemote workFlexible hours
$88.85k
...Utilization Management (UM) Claims Review Nurse RN II Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) L.A. Care Health... ...management skills. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted...SuggestedL.A. Care Health Plan
Los Angeles, CA1 day ago- American Traveler is hiring an RN Case Manager for an inpatient Care Management role requiring CA RN licensure and RN case management... ...and timeliness of interdisciplinary care plans and resource utilization Provides oversight and data collection for regulatory and accreditation...SuggestedLocal areaDay shift
- An established industry player in healthcare is seeking a dedicated Utilization Management Nurse to enhance patient care efficiency. In this vital role, you will review patient files and treatment methods, ensuring that every patient receives the necessary treatments and...SuggestedRelocation package
- ...& development ~ Vision insurance Outpatient Case Management West Los Angeles VAMC 11301 Wilshire Blvd Los Angeles... ...Opportunities Job Summary We are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse on the...For contractorsWork at officeImmediate startRelocation packageMonday to FridayFlexible hours
Presidential Staffing Solutions, LLC
Los Angeles, CA9 days ago $30 - $34 per hour
A health services company is seeking a Utilization Management Review Nurse in Monterey Park, CA. This hybrid role includes conducting reviews for inpatient admissions and outpatient procedures, ensuring compliance with regulations, and working collaboratively with the team...Hourly payWeekend work- Molina Healthcare is seeking a Nurse Reviewer to support utilization management in Arizona. You will review documentation to confirm medical necessity and appropriate care level using MCG/InterQual guidelines and Molina policies, validating records to ensure accurate reimbursement...
$65.8k - $130.8k
Description The UM Denial Nurse Reviewer supports high-quality, cost-effective care by applying clinical knowledge,... ...Current CA LVN licensure required Two or more years of utilization review/utilization management experience in an HMO, MSO, IPA, or health plan environment...$222k - $256.3k
About This Role The Utilization Management Nurse Director at Kaiser Permanente is responsible for establishing best practice models, strategic planning, and designing patient care delivery systems. This role is ideal for experienced nursing leaders who excel in collaboration...Full time- Keck Medicine of USC seeks a registered nurse to manage admissions and perform concurrent or retrospective reviews in an acute care setting.... ...license (BSN preferred) and AHA BCLS certification; recent utilization/quality/case management experience is preferred. This...
- American Traveler, LLC. is seeking an experienced RN Case Manager for a Utilization Review/Case Management role in a hospital setting. The ideal candidate holds an active California RN license and has Epic EMR experience. The position offers a day shift schedule (8:30 AM...Local areaDay shift
$47.58 - $76.68 per hour
...of Southern California is hiring for a position that involves managing admissions and conducting patient reviews in accordance with established... ..., ideally including a BSN. Experienced candidates in Utilization/Quality/Case Management will thrive in this supportive...Hourly pay- ...Registered Nurse - ICU Duration: 26 Weeks Start: 12/27/2024 Job Type: Travel Minimum Guaranteed... ...care with other disciplines while utilizing critical thinking, professional and supervisory... ..., Equity, and Inclusion (DEI). We have managed and Implemented Talent Acquisition and...Contract workWork experience placement
Accede Solutions Inc.
Glendale, CA3 days ago - ...Registered Nurse - Case Management Duration:13 Weeks Start:03/10/2025 Job Type: Travel Minimum Guaranteed Hours: 40 Jobs Notes:... ...Discusses with physicians, the appropriateness of resource utilization, consultations, treatment plan, estimated length of...Contract workWork experience placementMonday to FridayWeekend workDay shift
Accede Solutions Inc.
Glendale, CA3 days ago $110k
Overview The Nurse Clinical Supervisor, UM Denial Compliance oversees the denial process within the utilization management (UM) department, ensuring that all denials are handled efficiently, accurately, and in full compliance with regulatory, accreditation, and health plan...Casual workRelocation package- University of Southern California's Keck Medicine invites a Nurse to support admissions and reviews at USC Verdugo Hills... ...RN license ( BSN preferred) and BCLS certification; prior Utilization/Quality/Case Management experience in acute settings is preferred. #J-18808-...
- ...development and empowerment of our nurses and have received Magnet... ...and ancillary personnel utilizing both professional and supervisory... .../Certifications: Registered Nurse (RN) licensure in the... ...with staff members and management with minimal incidents of absence...Full timeWork experience placementShift workDay shift
Adventist Health
Burbank, CAa month ago - UCLA Outpatient Clinics in Los Angeles is seeking a UM Denial Nurse Reviewer to apply clinical knowledge, policies, and regulatory guidelines to review adverse determinations and ensure accurate, timely notifications. The role involves reviewing denials for proper documentation...
- AvoCare Palliative- Part Time Registered Nurse-Bilingual/Spanish# AvoCare Palliative- Part Time... ...care that focuses on comfort, symptom management, and emotional well-being. We are... ...priorities and maintains productivity utilizing time management.· Provides appropriate...Permanent employmentFull timePart timeImmediate startFlexible hours
$1,973 - $2,068 per week
...Registered Nurse (RN) | Utilization Review Location: Burbank, CA Agency: GQR Healthcare Pay: $1,973 to $2,068 per week Shift Information... ...RN in Burbank, California, 91505! Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job...Hourly payWeekly payFull timeContract workImmediate startShift workTravelNurseSource
Burbank, CA2 days ago$3,499 per week
...Registered Nurse (RN) | Utilization Review Location: Los Angeles, CA Agency: GQR Healthcare Pay: $3,499 per week Shift Information... ...Date: ASAP About the Position **Job Title: Case Manager • Registered Nurse (Days)** Join our team in Woodland...Full timeContract workImmediate startShift workDay shiftGQR Healthcare
Los Angeles, CA2 days ago$2,213 - $2,308 per week
...Registered Nurse (RN) | Utilization Review Location: Beverly Hills, CA Agency: GQR Healthcare Pay: $2,213 to $2,308 per week Shift... ...: ASAP About the Position Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location...Hourly payWeekly payFull timeContract workImmediate startShift workGQR Healthcare
Beverly Hills, CA2 days ago$2,099 - $2,194 per week
...Registered Nurse (RN) | Utilization Review Location: Burbank, CA Agency: GQR Healthcare Pay: $2,099 to $2,194 per week Shift Information... ...: ASAP About the Position Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job...Hourly payWeekly payFull timeContract workImmediate startShift workGQR Healthcare
Burbank, CA2 days ago$3,499 per week
...Registered Nurse (RN) | Utilization Review Location: Los Angeles, CA Agency: GQR Healthcare Pay: $3,499 per week Shift Information... ...RN in Los Angeles, California, 91367! **Job Title: Case Manager • Registered Nurse (Days)** Join our team in Woodland...Full timeContract workImmediate startShift workDay shiftTravelNurseSource
Los Angeles, CA2 days ago$47.2 - $63.45 per hour
...Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from... ...experience post-graduation of an accredited school of nursing and a current state Registered Nurse license # At least one year experience in case...Full timePart timeWork experience placementLocal areaShift workAfternoon shiftSt. Francis Medical Center
Lynwood, CA2 days ago- ...Commission-certified staffing agency, is seeking a quality Case Manager Registered Nurse (RN) for a travel assignment with one of our top... ...Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN *Weekly payment estimates are...Hourly payWeekly payContract workImmediate start
MedPro Staffing
Glendale, CA1 day ago - Kaiser Permanente in Downey, CA seeks an experienced Registered Nurse to coordinate discharge planning and post-acute care. Works with MDs to assess admissions and plan appropriate levels of care, ensuring safe transitions and cost-effective care. You will collaborate...
- American Traveler is seeking an RN Case Manager for an inpatient Care Management role in a CA hospital. The position requires CA RN licensure and RN Case Management certification, with BLS, and inpatient CM experience. Day shift, 40 hours per week, 8:00 AM to 4:30 PM, Sunday...Day shift
$920 per week
...Case Manager Registered Nurse (RN) Setting: Healthcare Facilities Job Type: Travel Pay: $920 / Week Hours: 40.00 Location:... ...care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical...Weekly payContract workWork at officeLocal areaAmergis
Los Angeles, CA1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Registered Nurse - Utilization Management. Be the first to apply!
Related searches
- injection rn Los Angeles, CA
- pediatric icu rn Los Angeles, CA
- connect rn Los Angeles, CA
- pediatric oncology rn Los Angeles, CA
- davita rn Los Angeles, CA
- womens health rn Los Angeles, CA
- registered nurse ii Los Angeles, CA
- rn per diem nurse Los Angeles, CA
- hospice registered nurse Los Angeles, CA
- operating room rn Los Angeles, CA