2603 Remote Utilization Rn jobs in San Francisco,CA

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Border Patrol Agent (BPA) Entry Level New Hire Sign-On and Retention Incentives

United States Customs and Border Protection

San Francisco, CA 94118

$49,739-$89,518/yr

Bilingual Preferred

New, Posted 1 day ago

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Director, Utilization Management

Alameda Health System

Oakland, CA 94602

~ 23 min OnsiteUrgently HiringHealth InsurancePaid Time OffRetirement Benefit

Bachelor's degree in Nursing
Three years of utilization review experience. Health insurance company and/or acute care hospital, post-acute and psych; three years of InterQual and/or MCG. Strong clinical nursing background.
Valid license to practice as a Registered Nurse in the State of California.

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New, Posted 4 hours ago

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Data Entry Clerk - Remote Work From Home (Part-Time / Full-Time)

Apex Focus Group

San Francisco, CA 94199

$750/wk

RemoteNo Experience

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RN - Case Manager - AS Utilization Management - Part Time - 8 Hour - Days

John Muir Health

Walnut Creek, CA 94598

$89.23-$121.58/hr

~ 36 min Onsite

RN
RN Registered Nursing - California Board of Nursing Required
Bachelor's Degree Accredited School of Nursing Required
BLS Basic Life Support - American Heart Association Required
3 years Nursing - Medical/Surgical Preferred
3 years Nursing - Critical Care Preferred
2 years Care Coordination - Case Management Preferred or Equivalent Work Experience
Strong written and verbal communication skills.
Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning.
Working knowledge of common diagnoses and procedures and the impact this will have to patients/families and their ability to manage their care outside of the hospital.
Knowledge of individual and family development over the life span, and the influences of cultural and spiritual values in health care.
General knowledge of commercial coverage plans and usually covered benefits. Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements such as ACOs, DRGs, Full Risk, etc.
Strong understanding of the criteria, rules and regulations around Inpatient, Observation and Outpatient levels of patient management.
Strong knowledge of geriatrics and the impact to health and function in the aged as well as a working knowledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc.
Clear understanding of the role of the inpatient Social Worker and Palliative Care Resources.
Ability to plan, organize, manage time and prioritize work in collaboration with others.
Ability to work independently and as a part of a multidisciplinary team.
Effective problem solving and conflict resolution skills.
Ability to work respectfully and creatively with clients of diverse functional abilities, social, economic, and cultural backgrounds to support both client autonomy and client safety.
Leadership skills to delegate and provide direction/guidance to staff and hold others accountable.
Able to learn and work in a variety of computer programs, including EPIC, Allscripts, InterQual, and Microsoft Outlook.