Top 20 Clinical documentation & utilization review nurses Jobs in Redlands, Ca

Utilization Specialist PRN
Pacific Grove —Riverside, CA
- $31 - $50 an hour
- PRN
- CPR Certification
- Nursing
- RN License
- Employee assistance program
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
Prior Authorization LVN
LSMA Management Inc —San Bernardino, CA
- $35 - $40 an hour
- Nursing
- Microsoft Excel
- Microsoft Outlook
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
Utilization Review RN
Prime Healthcare Management Inc —Ontario, CA
- $71,760 - $104,000 a year
- Full-time
- Nursing
- RN License
- Computer literacy
- Health insurance
- Dental insurance
Concurrent Case Management LVN
LSMA Management Inc —San Bernardino, CA
- $35 - $40 an hour
- Full-time
- Nursing
- LVN
- BLS Certification
5d
Denial LVN
LSMA Management Inc —San Bernardino, CA
- $35 - $40 an hour
- Nursing
- LVN
- Office
8d
MDS Coordinator
Extended Care Hospital of Riverside —Riverside, CA
- $36 - $40 an hour
- Full-time
- Background check
- Skilled nursing facility
- LVN
- 401(k)
- Flexible schedule
Quick Apply
11d
CDIS - Clinical Doc Improvement Specialist - Hemet, CA
KPC GLOBAL MEDICAL CENTERS INC. —Hemet, CA
- $44 - $68 an hour
- Full-time
- LVN
- RN License
- Office
Quick Apply
MDS Coordinator (RN)
Rockwell Care —Yucaipa, CA
- $50 - $60 an hour
- 8 hour shift
- Skilled nursing facility
- RN License
- Nursing home
- Paid holidays
- Disability insurance
Quick Apply
MDS Coordinator (Registered Nurse)
Rockwell Care —Yucaipa, CA
- $50 - $60 an hour
- 8 hour shift
- Skilled nursing facility
- RN License
- Nursing home
- Paid holidays
- Disability insurance
Quick Apply
MDS Coordinator/LVN
Sun Mar Health Care —Riverside, CA
- Full-time
- Skilled nursing facility
- Mid-level
Quick Apply
Registered Nurse - Case Management
San Gorgonio Memorial Hospital —Banning, CA
- $42.00 - $57.01 an hour
- Full-time
- Nursing
- RN License
- Hospital
- 403(b) matching
- AD&D insurance
CDS Trainee
Prime Healthcare Management Inc —Ontario, CA
- $26.04 - $29.69 an hour
- Full-time
- Nursing
- Computer literacy
- Computer skills
- Health insurance
- Dental insurance
12d
RAC Manager
Prime Healthcare Management Inc —Ontario, CA
- $71,760.00 - $94,619.20 a year
- Full-time
- Mid-level
- Master's degree
- Bachelor's degree
- Health insurance
- Dental insurance
MDS Nurse
Riverside PostAcute Care —Riverside, CA
- $29 - $35 an hour
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
Quick Apply
Epic ClinDoc Analyst
ClinDCast LLC —United States
- Full-time
- Remote
- Mid-level
- Analysis skills
- 2 years
Quick Apply

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Utilization Specialist PRN
Pacific Grove —Riverside, CA
Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or…
$31 - $50 an hour
Clinical Documentation Specialist 4 HX - Clinical Doc Integrity - FT Days HYBRID
University of California, Irvine —Irvine, CA
Strong clinical knowledge with ability to interpret clinical documentation. Knowledge of laws, rules and regulations regarding appropriate clinical…
$125,363.52 - $242,333.28 a year
3d

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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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The Ohio State University Wexner Medical Center —Columbus, OH
The Clinical Quality Auditor will assist to identify and facilitate opportunities for improvement in the delivery of patient care related to clinical care,…

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Utilization Specialist PRN

Pacific Grove -
Riverside, CA

Apply Now

Job Details

PRN
$31 - $50 an hour

Benefits

Employee assistance program

Qualifications

CPR Certification
BLS Certification
High school diploma or GED

Full Job Description

Overview:

Pacific Grove Hospital in Riverside, CA., is a leader in behavioral healthcare, providing superior healthcare treatment to the people, communities, and military installations we serve. We are a private inpatient 68 bed acute psychiatric facility with out-patient services, dedicated to the treatment of behavioral health and substance abuse services. Come join TEAM PGH as a UR Specialist!

Flexible scheduling
Competitive Pay
Employee Assistance Program (EAP)

Hourly pay range: $31-50 DOE and licensure held

PURPOSE STATEMENT:

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

Responsibilities:

ESSENTIAL FUNCTIONS:

Act as liaison between managed care organizations and the facility professional clinical staff.
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
Conduct quality reviews for medical necessity and services provided.
Facilitate peer review calls between facility and external organizations.
Initiate and complete the formal appeal process for denied admissions or continued stay.
Assist the admissions department with pre-certifications of care.
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.

Qualifications:

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

Required Education: High school diploma or equivalent.
Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred

LICENSES/DESIGNATIONS/CERTIFICATIONS:

Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
First aid may be required based on state or facility requirements.

ADDITIONAL REGULATORY REQUIREMENTS:

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

PACGRV

Apply Now

Refine Your Search

clinical documentation & utilization review nurses jobs in redlands, ca

Utilization Specialist PRN

CA Utilization Review Nurse I

Prior Authorization LVN

Provider Quality Review Nurse, RN

Utilization Review RN

Concurrent Case Management LVN

Denial LVN

MDS Coordinator

CDIS - Clinical Doc Improvement Specialist - Hemet, CA

MDS Coordinator (RN)

MDS Coordinator (Registered Nurse)

MDS Coordinator/LVN

Registered Nurse - Case Management

CDS Trainee

RAC Manager

MDS Nurse

Epic ClinDoc Analyst

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