Managed Care Resources MCR Jobs in Los Angeles

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14 Managed Care Resources MCR jobs in Los Angeles, California found on Monster.

Jobs 1 to 14 of 14
This is a position that focuses on utilization review including assessment of medical records for appropriateness, level of care provided. You will assess utilization of treatment, modalities, medications, services and application of treatment protocols. A team approach with other members of internal staff is important. Requirements: California Nurses license, Registered Nurse (RN) Utilization Rev...
RN Case Manager - Medical Center About the Job: Responsible for assessing, planning, implementing, and evaluating the needs of patients for discharge planning and utilization review. Level of Care, Length of Stay, Continued Stay Reviews Coordinate utilization management, care facilitation, and discharge planning Coordinate discharge planning with physicians, nursing, and social services, patient a...
A national outpatient organization is looking to add a veteran Case Manager (RN) to their established team. Under new leadership, the case manager will be responsible for complex and catastrophic cases within their existing chronic disease patient population. Knowledge of Medi-Medi guidelines is a must, and familiarity with Interqual is also preferred given the amount of interface with hospitals i...
The Catastrophic Case Manager (CCRNCM) is responsible for providing care management services to members of the organization's Medicare and Medicaid health plans of California. Key responsibilities include: Intense complex care management of members meeting the criteria of catastrophic needs. These will include those members identified with acute care hospitalization(s) More than one ER visit in a...
Case Manager, Inpatient (Concurrent Review) Monday - Friday; 8/hr/day About the Job: Utilization Review, Concurrent Review, Discharge Planning, Transfers Level of Care and length of stay reviews (SI / IS) Reviews, verifies and processes requests for referrals, inpatient and outpatient procedures, home health services, DME Strong problem solving and organizational skills Knowledgeable of: DRG and I...
Nurse Case/Care Manager - Telephonic, Desk Job About the Job: · Care Coordination · Reviews, verifies and processes requests for referrals/authorizations of services. · Strong problem solving and organizational skills in a fast paced environment. · Coordination of care and quality of care. Knowledgeable of: · Effective charting practices and guidelines. · Principles and practices of health care, h...
Inpatient Concurrent Review Nurse Medical Office Monday-Friday; 40 hours per week RN Job Description as follows: Coordination of inpatient admissions, management of entire stay with IPA and health care team. Coordinate directly with the department of inpatient admissions, discharges and transfers as appropriate. Facilitation of movement of the patient through the continuum of care Communication wi...
Hospital, Inpatient RN Case Manager / Care Coordinator The Job: Concurrent Review Utilization Review Discharge Planning Authorizations (TARS) Case Management from Admission to Discharge Ability to: Responsible for assessing, planning, implementing, and evaluating the needs of patients for discharge planning and utilization review. Level of Care, Length of Stay, Continued Stay Reviews Coordinate ut...
The Discharge Planner, in conjunction with other members of the health care team is accountable for timely coordination of quality health care services to meet the patient's health care needs across the continuum of care. This position requires knowledge of the development stages as services are provided to infants, children, adolescent, pediatrics, adult and geriatric populations. The Discharge P...
Hospital - Case Manager Registered Nurse (RN) Full Time, 40 Hours Per Week About the Job: Concurrent review and analysis of inpatient records to determine if the patient's admission and continued hospital stay triggers any pre-defined quality indicators. Coordinate chart reviews for quality reports and clinical procedures Manage cases smoothly and increase patient/physician satisfaction. Track out...
Nurse Case Manager Monday - Friday; 8/hr/day Medical Management Office About the Job: Manages a caseload of patients by assessing the individual's needs made by the PCP/​Specialist.​ Utilization Review, Concurrent Review, Discharge Planning Reviews, verifies and processes requests for referrals, inpatient and outpatient procedures, home health services, DME Strong problem solving and organizationa...
RN Case Manager - Medical Center - 40 hours per week About the Job: Concurrent Review, Level of Care, Severity of Illness (SI), Intensity of Service (IS) and Discharge planning Process TARS, treatment authorizations requests as needed Coordinate chart reviews for quality reports and clinical procedures InterQual or Milliman Requirements Registered Nursing License (CA) About the Agency: Managed Car...
Review referral requests (routine, urgent & stat) for various office visits, outpatient and inpatient procedures using Milliman Care Guidelines to determine medical necessity Coordinate reviews, deferrals & denials with medical director, medical groups, health plans Create denial letters based on the MD's review and guidelines Submit treatment authorization requests to health plans as needed Deter...
This is a position that focuses on utilization review including assessment of medical records for appropriateness, level of care provided. You will assess utilization of treatment, modalities, medications, services and application of treatment protocols. A team approach with other members of internal staff is important. Requirements: California Nurses license, Registered Nurse (RN) Utilization Rev...

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