Top 11 Utilization review nurse Jobs in Camarillo, Ca

Practice Advancement Specialist RN
Livingston Memorial VNA —Ventura, CA
- $87,360 - $95,680 a year
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid training
- Mileage reimbursement
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Care Manager RN Full time Days
Providence Health and Services —Simi Valley, CA
- $57.28 - $88.92 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
3d
Medical Field Case Manager
Enlyte —Oxnard, CA
- $95,000 - $100,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- RN License
- Travel reimbursement
- Health savings account
1d
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —West Hills, CA
- $2,792.14 a week
- 8 hour shift
- Acute care
- Nursing
- RN License
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9d
Registered Nurse | Review Analyst I | Remote | Detroit, MI | Contract
Walker Healthforce, LLC —United States
- Contract
- Remote
- Nursing
- RN License
- 3 years
- Health insurance
- Dental insurance
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3d

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Appeals RN - Care Management Per Diem - REMOTE
Providence —Torrance, CA
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental,…
$57.28 - $88.92 an hour
2d
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —Los Angeles, CA
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
$30.37 - $59.21 an hour

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Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per…
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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…

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utilization review nurse jobs near camarillo, ca

Practice Advancement Specialist RN

Livingston Memorial VNA -
Ventura, CA

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Job Details

Full-time
$87,360 - $95,680 a year

Benefits

Paid training
Mileage reimbursement
Paid holidays
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Tuition reimbursement
Paid time off
Vision insurance
Employee discount
403(b)

Qualifications

Microsoft Word
Computer operation
Microsoft Excel
Computer literacy
Professional ethics
BLS Certification
Driver's License

Full Job Description

Description:

Livingston Memorial is looking for a Full Time, 40 hours a week, Practice Advancement Specialist Registered Nurse to join our Quality Team.

Come be a part of a company whose mission for the last 78 years is to deliver the highest quality, compassionate in-home healthcare and support services to Ventura County residents!

Job Summary

The purpose of this position is to assess, monitor and advance clinical practices, particularly in the areas of compliance, documentation, PPS and OASIS case management including utilization review, and critical thinking. This person works collaboratively with the QAPI Manager and the Director of Patient Care Services providing information regarding OASIS competency and care coordination capabilities of the geographic team members.

What You'll Do

Establish and monitor a team-based Compliance Program, focusing on issues such as fraud detection and prevention, adherence to federal and state regulations, and applicable clinical practice standards, and LMVNA policies and procedures.
Review OASIS documentation and Plans of Care with the assistance of other QI staff as needed and communicate with individual staff members regarding discrepancies and/or errors and tracks and trends individual staff performance for education and training purposes.
Work with clinicians and the clinical supervisors to make recommendations for care plan, nursing frequency and duration, and order of other disciplines.
Review, validate, submit, and track OASIS to CMS, ensuring timely and accurate filings while resolving submission errors and maintaining regulatory compliance.
Works with Data Analyst to complete Home Health clinical record audits.
Utilize Careficient and Strategic Healthcare Programs (SHP) analytics and reporting tools to monitor quality outcomes, identify performance trends, and implement strategies to achieve and maintain the organization's Low Utilization payment Adjustment (LUPA) goals.
Participate in patient case conferences for each team as scheduled.
Monitor the quality of clinical documentation to implement strategies to improve clinical documentation; monitors medical records for completion time.
Identifies and monitors indicators of compliance, quality documentation, and clinical outcomes. Responsible for implementing strategies to improve clinical outcomes when indicated.
Use available data to track utilization and outcome information that is patient and staff specific.
Provides input and participates in ongoing staff competency and evaluation of performance with the Director of Patient Care Services.
Communicates findings, issues and problems regarding compliance, documentation and clinical practice to the QI Manager and the Director of Patient Care Services.
Promotes and facilitates understanding of the fiscal impact of all clinical practices and documentation. Maintains knowledge of third-party reimbursement requirements and regulation.
Performs other related duties as assigned.

Requirements:

What We're Looking For

Valid California Registered Nurse License, Physical or Occupational Therapist License
Valid Basic Life Support Certification
Valid Driver License and auto insurance
Must reside within Ventura County
Minimum 2 years home care experience preferred
Comprehensive knowledge of Medical Prospective Payment system and fraud issued in home care preferred
Knowledge of computer, proficient with Microsoft Word and Excel
Good verbal and written communication skills.
High level of attention to details.
Able to work independently, take ownership and responsibility of tasks.
Strong professional ethics, discretion and judgment.
Good organizational skills.

What We Offer

Competitive hourly pay
Mileage reimbursement
Paid training and ongoing education
Bilingual Stipend
Supportive team environment
A chance to truly make a difference in the lives of patients and families

Benefits

Medical, Dental & Vision Insurance
403(b) Retirement plan
Company Paid Life & Disability Insurance
Flexible Spending Accounts
Ancillary Insurance (Critical Illness, Accident, Life, Hospital)
Paid Time Off (PTO)
Floating Holiday
Holiday Pay
Employee Discounts
Tuition Reimbursement
Continuing Education opportunities
Employee Recognition Program

Join a company that is a cornerstone in the community and a leader in healthcare!

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Refine Your Search

utilization review nurse jobs in camarillo, ca

Practice Advancement Specialist RN

Care Manager RN Full time Days

Medical Field Case Manager

Travel RN - Case Management/Utilization Review - Case Management

Registered Nurse | Review Analyst I | Remote | Detroit, MI | Contract

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