Top 37 Utilization review nurse Jobs in Loma Linda Ca

RN Case Manager
Institute on Aging —San Bernardino, CA
- $90,000 - $100,000 a year
- Full-time
- Remote
- Background check
- Nursing
- Addiction Medicine
Quick Apply
CA Utilization Review Nurse I
CorVel Corporation —Rancho Cucamonga, CA
- $30.64 - $45.80 an hour
- Full-time
- Remote
- Nursing
- LVN
- RN License
- Health savings account
- Disability insurance
Quick Apply
Utilization Specialist PRN
Pacific Grove —Riverside, CA
- $31 - $50 an hour
- PRN
- CPR Certification
- Nursing
- RN License
- Employee assistance program
Registered Nurse - Utilization and Care Transitions
Neighborhood Healthcare —Riverside, CA
- $50.10 - $75.10 an hour
- Monday to Friday
- CPR Certification
- Nursing
- Skilled nursing facility
- Health insurance
- Dental insurance
Quick Apply
Utilization Specialist Full-time
Pacific Grove —Riverside, CA
- $31 - $50 an hour
- Full-time
- Acute care
- CPR Certification
- Nursing
- Health savings account
- Paid holidays
Clinical Review Nurse - Prior Authorization
Akido —Chino, CA
- $62,400 - $93,600 a year
- LVN
- RN License
- Mid-level
Quick Apply
Provider Quality Review Nurse, RN
Inland Empire Health Plan —Rancho Cucamonga, CA
- $91,249.60 - $120,910.40 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Word processing
- Disability insurance
- Health insurance
Care Manager-RN
Loma Linda University Health —Redlands, CA
- $59.77 - $80.39 an hour
- Full-time
- Spanish
- Nursing
- Microsoft Outlook
Care Manager (Case Management)
Redlands Community Hospital - UTILIZATION MANAGEMENT —Redlands, CA
- $49.98 - $72.47 an hour
- Per diem
- CPR Certification
- Nursing
- RN License
2d
Case Manager (RN/LIC)
Riverside Medical Clinic —Riverside, CA
- $44.74 - $64.88 an hour
- Full-time
- Nursing
- RN License
- Mid-level
4d
Concurrent Case Management LVN
LSMA Management Inc —San Bernardino, CA
- $35 - $40 an hour
- Full-time
- Nursing
- LVN
- BLS Certification
Case Manager
Loma Linda University Health —Loma Linda, CA
- $59.18 - $79.60 an hour
- 8 hour shift
- Spanish
- Nursing
- Microsoft Outlook
2d
Concurrent Case Management RN
LSMA Management Inc —San Bernardino, CA
- $85,000 - $100,000 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
10d
Case Manager
Ontario Grove Healthcare & Wellness Centre —Ontario, CA
- $30 - $45 an hour
- Part-time
- Mid-level
- Administrative experience
- Bachelor's degree
Quick Apply
9d
Case Manager - RN. Children's Hospital
Loma Linda University Health —Loma Linda, CA
- $59.18 - $79.60 an hour
- Full-time
- Nursing
- RN License
- Customer service
per diem IVF coordinator
Loma linda fertility and wellness center —San Bernardino, CA
- From $24 an hour
- Part-time
- Background check
- Nursing
- RN License
- 401(k)
Quick Apply
11d
Case Manager (RN) - Utilization Management
Chino Valley Medical Center —Chino, CA
- $43.25 - $58.21 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
RN Case Manager
Vanura Homehealth Services Inc —Rancho Cucamonga, CA
- $45 - $50 an hour
- Full-time
- RN License
- HIPAA
- Mid-level
Quick Apply
Registered Nurse Clinical Supervisor
Kinder Care Home Health, Inc —Redlands, CA
- $40 - $45 an hour
- Full-time
- Nursing
- RN License
- Mid-level
- Paid time off
Quick Apply
6d
Home Health Registered Nurse Case Manager
NU CARE HOME HEALTH INC. —Rancho Cucamonga, CA
- $80,000 - $90,000 a year
- Full-time
- Nursing
- RN License
- HIPAA
Quick Apply

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utilization review nurse jobs near loma linda ca

RN Case Manager

Institute on Aging -
San Bernardino, CA

Quick Apply

Job Details

Full-time
$90,000 - $100,000 a year

Qualifications

Computer operation
Nursing
RN License
Experience working with individuals with disabilities
Computer literacy
BLS Certification
Working with geriatric patients
Working with seniors
Managing patients as a nurse case manager
Driver's License
Medical treatment knowledge
Driving
Experience working with adults with disabilities
Computer skills
Acute care experience
Direct patient care in social services case management
Nursing

Full Job Description

Job Description Summary:
IOA's Community Living Services division is an innovative and revolutionary healthcare model that allows seniors and adults with disabilities to live at home longer by transitioning them out of nursing homes and back into the community by partnering with health plans and Medi-Cal. This inventive, nationally recognized model is one of the most promising for seniors to date, transforming their lives by providing them with a higher quality and more independent life and saving millions of dollars for healthcare systems. .

The HCBA Medi-Cal Waiver program within Community Living Services division provides care management services to persons at risk for nursing home or institutional placement. The care management services are provided by a multidisciplinary care team comprised of a nurse and social worker.

The care management team coordinates Waiver and State Plan services (e.g., medical, behavioral health, In-Home Supportive Services, etc.), and arranges for other available long-term services and support available in the local community. Care management and Waiver services are provided in the Participant’s community-based residence. This residence can be privately owned, secured through a tenant-lease arrangement, or the residence of a Participant’s family member.

Job Description

IOA is seeking a full-time Case Manager/Registered Nurse (RN). The Case Manager/RN will conduct comprehensive nursing health assessments of participants’ medical needs, diagnose functional and cognitive abilities and environmental and social needs to determine which service(s) are required to meet participants’ needs and preferences in the community. This position requires driving throughout Riverside and San Bernardino County depending on your assigned area with occasional cases out of your region.

Other key duties and responsibilities include, but may not be limited to the following:

Documenting assessment, case notes, care coordination, and utilization management within MedCompass, a population health management software
Working with the participants, their legal representatives, circle of support, and primary care physicians
develop goals associated with the participant’s assessed needs, individual circumstances, and preferences
Develop a Plan of Treatment (POT) to mitigate risk and minimize disruptions in services
identify when services identified in the POT are available through friends, family, and/or publicly funded programs
implement the POT, which includes identifying service providers and community resources to help assure the timely, effective, and efficient mobilization and allocation of the services
Identify (and train, if necessary), backup caregivers who are willing and able to provide unpaid support when waiver service providers do not arrive when scheduled.
Providing information, education, counseling, and advocacy to, and on behalf of participants
Establishing a care coordination schedule based on the needs and acuity of the participant as determined by their initial service needs assessment and subsequent reassessments
Monitoring the delivery of HCBA Waiver services to ensure participants are receiving services as authorized in their POTs
Monitoring the quality of the authorized services by maintaining ongoing contact with participants - including a monthly face-to-face visit or telephone call - to monitor for changes in health, mood, social integration, functionality, and overall well-being
Conducting annual face-to-face visits, reassessments, and care plan updates
Following up with the participant after Emergency Department and In-patient facility admissions

REQUIRED QUALIFICATIONS

Current, unencumbered license to practice as an RN in the State of California
Current Basic Life Support (BLS) certification
A minimum of 1000 hours of experience in the previous two years, in an acute care hospital caring for individuals with the care need(s) of individuals at the levels of care specified in this waiver
A valid driver's license and proof of insurance

A minimum of 2000 hours of experience in the previous three years in an acute care hospital caring for individuals with the care need(s) of individuals at the levels of care specified in this waiver
A minimum of 2000 hours of experience in the previous five years working for a licensed and certified home health agency caring for individuals with the care need(s) of individuals at the levels of care specified in this waiver
A minimum of 2000 hours of experience in the previous five years in an area not listed above, that in the opinion of DHCS, would demonstrate appropriate knowledge, skill and ability in caring for individuals at one or more of the levels of care specified in this waiver
Experience establishing short and long-range goals for patient care which contribute to a continuum of care focus, and patient care will be delivered in accordance with the professional nursing process, which resulted in the delivery of quality patient care
Experience with, and understanding the medical diagnoses and medication associated with functionally impaired adults and older adults
Exceptional communication and presentation skills relating to functionally impaired adults and older adults, their support systems and teams of health professionals
Demonstrated case management experience and skills within the community health care delivery system
Excellent detail orientation and problem-solving skills
Demonstrated ability to prioritize multiple critical tasks
Excellent Computer literacy

DESIRED QUALIFICATIONS

Experience working with individuals with mental and/or behavioral health diagnoses and substance abuse disorders
Exceptional interpersonal, oral and written communication skills

COMPENSATION:
Range: $ 90,000- 100,000/Annual

This amount is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any specific employee, which is always dependent on actual experience, education and other factors.

This range does not include any additional equity, benefits, or other non-monetary compensation which may be included.

Job Type: Full-time

Pay: $90,000.00 - $100,000.00 per year

Location:

San Bernardino, CA (Required)

Work Location: Remote

Quick Apply

Refine Your Search

utilization review nurse jobs in loma linda ca

RN Case Manager

CA Utilization Review Nurse I

Utilization Specialist PRN

Registered Nurse - Utilization and Care Transitions

Utilization Specialist Full-time

Clinical Review Nurse - Prior Authorization

Provider Quality Review Nurse, RN

Care Manager-RN

Care Manager (Case Management)

Case Manager (RN/LIC)

Concurrent Case Management LVN

Case Manager

Concurrent Case Management RN

Case Manager

Case Manager - RN. Children's Hospital

per diem IVF coordinator

Case Manager (RN) - Utilization Management

RN Case Manager

Registered Nurse Clinical Supervisor

Home Health Registered Nurse Case Manager

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