Top 152 program administrator Jobs in alhambra, ca

RN Utilization Management Full Time
Martin Luther King, Jr. Community Hospital —Los Angeles, CA
- $52.25 - $80.99 an hour
- Full-time
- Background check
- Spanish
- Nursing
- Disability insurance
- Health insurance
Quick Apply
2d
Clinical Operations Manager
Therapeutic Play Foundation —Los Angeles, CA
- $105,000 - $125,000 a year
- Full-time
- Hybrid work
- School experience
- LMFT
- Licensed Clinical Social Worker
Quick Apply
Medical Director - Psychiatrist (Women's Health)
Precise Behavioral INC. —California
- $250,000 - $350,000 a year
- Full-time
- Remote
- Background check
- Medicine
- Psychiatry
- Health insurance
- Dental insurance
Quick Apply
Pediatric School Speech Pathology | Paramount, California
ProCare Therapy —Paramount, CA
- $45.53 - $72.53 an hour
- 8 hour shift
- School experience
- Mid-level
- Pediatrics
- Opportunities for advancement
Quick Apply
RN Utilization Mgmt Full-Time Day
Martin Luther King, Jr. Community Hospital —Los Angeles, CA
- Full-time
- Spanish
- Nursing
- RN License
3d
Machining Tech V, Crimper- 1st Shift
Howmet Aerospace —Fullerton, CA
- $23.86 - $40.57 an hour
- Full-time
- Basic math
- Mid-level
- High school diploma or GED
- Paid holidays
- Health insurance
Quick Apply
2nd Shift Centerless Grind Technician
Howmet Aerospace —Torrance, CA
- $21 - $35 an hour
- Full-time
- Mid-level
- Assembly
- US work authorization
- Paid holidays
- Health insurance
Quick Apply
Machining Tech V, Multi Spindle Screw Machine- 2nd Shift
Howmet Aerospace —Fullerton, CA
- $23.86 - $40.57 an hour
- Full-time
- English
- Mid-level
- High school diploma or GED
- Paid holidays
- Health insurance
Quick Apply
2d
Emergency Preparedness Program Administrator II
JPL/NASA —Pasadena, CA
- $94,744 - $111,800 a year
- Extended hours
- Research
- Master's degree
- Presentation skills
- Dental insurance
- Paid time off
Direct Support Professional
Elwyn —Temple City, CA
- $23 an hour
- Serving
- Clean driving record
- Current TB test
- Paid training
- Health insurance
Quick Apply
Student Services Program Assistant
Rio Hondo College —Whittier, CA
- $5,617.37 - $7,194.63 a month
- Online Application
- Microsoft Outlook
- Ability to walk for extended periods
- Writing skills
4d
Academic Program Administrator
USC —Los Angeles, CA
- $75,000 - $85,000 a year
- Full-time
- Surgery
- Customer service
- Office
Program Administrator - Safety and Emergency Management - Full Time 8 Hour Days (Exempt) (Non-Union)
Keck Medical Center of USC —Los Angeles, CA
- $68,640 - $112,370 a year
- 8 hour shift
- Remote
- Background check
- Master's degree
- Analysis skills
- Work from home
1d
Program Coordinator
Tarzana Treatment Centers, Inc —Long Beach, CA
- $29.58 - $37.02 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Bachelor's degree
- Paid holidays
- Health insurance
Quick Apply
Program Administrator - Safety and Emergency Management - Full Time 8 Hour Days (Exempt) (Non-Union)
USC —Los Angeles, CA
- $68,640 - $112,370 a year
- 8 hour shift
- Remote
- Master's degree
- Analysis skills
- Organizational skills
- Work from home
1d
Wrap-Up Program Administrator
Alliant Insurance Services —Los Angeles, CA
- $75,000 - $100,000 a year
- Email
- Remote
- Research
- Mid-level
- Experience equivalent to degree accepted
Quick Apply
JV Softball Coach
POLYTECHNIC SCHOOL —Pasadena, CA
- $21 - $23 an hour
- School experience
- Classroom
- CPR Certification
- Opportunities for advancement
Quick Apply
Personal Trainer I
YMCA of Metropolitan Los Angeles —Alhambra, CA
- $20 - $30 an hour
- Part-time
- 18 years or older
- CPR Certification
- High school diploma or GED
Quick Apply
1d
Client Care Operations Lead
Therapeutic Play Foundation —Los Angeles, CA
- $28 - $35 an hour
- Full-time
- Hybrid work
- Google Workspace
- HIPAA
- Mid-level
- Paid time off
- Opportunities for advancement
Quick Apply
11d
MAP Program Administrative Assistant - J. Ellingwood [Work Study]
Antioch University Santa Barbara —Los Angeles, CA
- Part-time
- Remote
- Databases
- University
- Entry level

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RN Utilization Management Full Time

Martin Luther King, Jr. Community Hospital -
Los Angeles, CA

Quick Apply

Job Details

Full-time
$52.25 - $80.99 an hour
2 days ago

Benefits

Disability insurance
Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
403(b)
Life insurance

Qualifications

Computer operation
Teamwork
RN License
Interpersonal skills
BLS Certification
Problem-solving
Computer skills
Associate's degree
Associate Degree in Nursing

Full Job Description

POSITION SUMMARY

The RN Utilization Management (RN UM) functions as a support liaisons for a variety of UM functions which may include: the e-TAR process, denials management, and the UM process. Coordinates care submission relating to the process of health care utilization from the point of patient admission to discharge. Assignments may also include management of the clinical denials process in collaboration with finance team. Processes will include arrangement and coordination of documentation for inpatient admissions with continued and extended hospital stays, and discharge review that determine medical necessity. The RN UM will complete and coordinate MCG as needed related to Observation patients including contact with insurance for authorization as needed. The RN UM ensures high quality care and efficiency of utilization available through healthcare resources, facilities, and services substantiating health plan reimbursement categories. This role communicates with the interdisciplinary care team to support the UR process and care management criteria.

ESSENTIAL DUTIES AND RESPONSIBILITIES

RN Utilization Management staff may work as assigned in one of the following assignments: ETARS management and/or denials management as well as routine UM functions (insurance authorizations, clinical reviews, and liaison) :

1. Daily coordination of support documents pertaining to the DNFB List of Medi-Cal patients.

2. Ensures completion of patient records and attachments prior to submitting them to Medi-Cal via e-TAR.

3. Assist with tracking submitted e-TARS to ensure deferrals and denials are followed-up within a timely fashion.

4. Reports e-TAR support progress and delays to Manager or Director of care management.

5. Participates in interdisciplinary team and department of revenue meetings to discuss e-TAR work flow, documentation necessity (attachments), process improvement, and submission timeliness.

6. Identifies and reviews observation patients daily; performs concurrent MCG/electronic review for continued stay or conversion to inpatient appropriateness reviews as needed.

7. Contacts insurance for pre-authorization prior to conversion; collaborates with CM RN to obtain order for admission if appropriate. Responsible for documentation of authorization information in Cerner

8. Coordinates with UM Care Coordinator to transfer clinical information to payer as needed.

9. Collaborates with interdisciplinary team, participants in team rounds to: (I) facilitate timely care, (2) assures quality of care throughout the hospital stay, and (3) minimizes adverse outcomes.

10. Assists with the initiation of appropriate referrals to the internal interdisciplinary team and outside provider networks (health plans, IPAs, and FQHCs) as indicated.

11. Communicates with admitting or PFS regarding the needs of the patient, payer, and provider documentation.

12. Patient needs are supported within the limitations of the existing individual beneficiary care structure.

13. Communicates relevant elements of the health plan benefits.

14. Documents and reviews all team member, physician, and patient/family communications and concerns pertaining to coordination of care and services.

15. Screens every patient chart to justify identified needs for assessments, documentation of medical necessity, and/or discharge planning needs if assigned.

16. Adheres to the Care Management Department policies and procedures.

17. Participates in the Quality and Performance Improvement Plan for the Care Management Department.

18. Considers the patient population served, age-specific criteria and the Jean Watson Model of Care in all patient/family care and interaction.

19. Collaborates with on-site care management team to support best practice guidelines.

20. Attends unit/department staff meetings as well as other meetings as assigned.

21. Maintain and complete Compass program training as assigned.

22. Other duties may be assigned such as denials management and appeals in lieu of other UM duties.

POSITION REQUIREMENTS

A. Education

· Associate’s degree in nursing required. BSN preferred.

B. Qualifications/Experience

· Minimum 3-5 years recent experience in Case Management or Utilization Management or Prior Authorization

· Current California Registered Nurse License. Certification in UM or CM is highly preferred

· Experience in MCG and/or Interqual required A team player that can follow a system and protocol to achieve a common goal

· Highly organized and well developed oral and written communication skills

· Confidence to communicate and outreach to other community health care organizations and personnel Demonstrates sound judgment, decision making and problem solving skills

C. Special Skills/Knowledge

· Bilingual language skills preferred (Spanish) Basic computer skills

· Current Basic Life Support (BLS)

· CCM Certification preferred

Pay: $52.25 - $80.99 per hour

Benefits:

403(b)
Dental insurance
Disability insurance
Employee assistance program
Health insurance
Life insurance
Paid time off
Tuition reimbursement
Vision insurance

Experience:

case management/utilization management/prior authorization: 3 years (Required)

License/Certification:

CA RN License (Required)

Work Location: In person

Quick Apply

Refine Your Search

program administrator jobs in alhambra, ca

RN Utilization Management Full Time

Clinical Operations Manager

Medical Director - Psychiatrist (Women's Health)

Pediatric School Speech Pathology | Paramount, California

RN Utilization Mgmt Full-Time Day

Machining Tech V, Crimper- 1st Shift

2nd Shift Centerless Grind Technician

Machining Tech V, Multi Spindle Screw Machine- 2nd Shift

Emergency Preparedness Program Administrator II

Direct Support Professional

Student Services Program Assistant

Academic Program Administrator

Program Administrator - Safety and Emergency Management - Full Time 8 Hour Days (Exempt) (Non-Union)

Program Coordinator

Program Administrator - Safety and Emergency Management - Full Time 8 Hour Days (Exempt) (Non-Union)

Wrap-Up Program Administrator

JV Softball Coach

Personal Trainer I

Client Care Operations Lead

MAP Program Administrative Assistant - J. Ellingwood [Work Study]

I want to receive the latest job alert for program administrator in alhambra, ca

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