Managed Care Resources MCR Jobs in Los Angeles

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

Jobs 1 to 6 of 6
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...
Ambulatory Case Manager – Office Setting Duties: Responsible for the care management (coordination of outpatient care) of members with catastrophic illnesses and the chronically ill while ensuring that quality standards are met by using clinical judgment to evaluate and assess. Apply case management concepts, principles, and strategies to develop a Plan of Care (Care Plan) that addresses the membe...
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...
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...
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...
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...

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