Referso Jobs

RN Utilization Management Reviewer

Sagility · Posted Jul 23, 2025

Open

Remote, United States
Remote
Full-time · Entry
$35–$40 per hour
1+ years

RN Utilization Management Reviewer

Sagility · Posted Jul 23, 2025

Open

Remote, United States
Remote
Full-time · Entry
$35–$40 per hour
1+ years

Clinical Compliance Coordinator

The Health Plan of West Virginia Inc · Posted Nov 5, 2026

Open

Wheeling, West Virginia, United States
1+ years

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Coordinate clinical compliance activities, oversee regulatory adherence, conduct audits, and produce reports to ensure accuracy and quality of clinical processes.

Responsibilities

Displays comprehensive understanding of all related Utilization Management (UM) processes and associated programs and systems.
Assists the Supervisor of Government Productions with troubleshooting daily prior-authorization concerns and related questions.
Assists with remediation plans regarding referral process, as needed. CMS & BMS guidelines.
Promotes and supports quality effectiveness of Healthcare Services by providing Staff education (monthly staff meetings) all-inclusive to referrals and compliance related to referrals in collaboration with Directors and manager(s).
Collaborates and shares knowledge and expertise with peers, supervisors, and other Health Plan staff.

Requirements

Bachelor's degree in a healthcare related field
Nice to have: certification in managed care or case management
Nice to have: pursuit of certification within 2 years

Skills

managed care experience knowledge of CMS knowledge of BMS

LVN Case Manager - Full Time, Days (Hybrid - Bellflower) - 10032

NOR Healthcare Systems · Posted Nov 3, 2026

Open

Bellflower, California, United States
Hybrid
Full-time
$28–$37 per hour
2+ years

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The LVN Case Manager prioritizes patient needs, collaborates with discharge coordinators, and coordinates safe discharge plans within an interdisciplinary healthcare team.

Compensation

Pay Rate: Min - $28.20 | Max - $36.60

Responsibilities

Prioritizes patient needs and collaborates with discharge coordinators to ensure safe discharge plans
Promotes and coordinates delivery of cost-effective patient care and transition of care
Advocates for patient self-determination and choice
Monitors and coordinates resource utilization throughout continuum of care
Performs utilization review using medical staff-approved criteria

Requirements

Current Licensure as a Vocational Nurse in the State of California
Two years of acute hospital case management experience OR completion of Internal Case Management training program
Nice to have: Bilingual skills to communicate effectively with patients and families
Nice to have: Familiarity with AllScripts Care Management
Nice to have: Proficiency with Milliman Care Guidelines or Interqual

Skills

Computer/EMR Proficiency and Literacy Knowledge of CMS, Medicare, Medi-Cal and Managed Care reimbursement

LVN Case Manager

NOR Healthcare Systems · Posted Nov 3, 2026

Open

Bellflower, California, United States
Hybrid
Full-time · Associate
$28–$37 per hour
2+ years

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The LVN Case Manager is responsible for prioritizing patient needs and collaborating with discharge coordinators to ensure a safe discharge plan, promoting safe and cost-effective patient care.

Compensation

Pay Rate: Min - $28.20 | Max - $36.60

Responsibilities

Prioritize patient needs and collaborate with discharge coordinators to ensure a safe discharge plan.
Collaborate with the interdisciplinary healthcare team to promote and coordinate the delivery of safe and cost-effective patient care, transition of care and discharge planning.
Advocate for patient self-determination and choice.
Practice clinical competence in discharge planning with awareness and respect for patient and family diversity.
Monitor and coordinate resource utilization throughout the continuum of care and evaluate timeliness of services.

Requirements

Vocational Nurse Licensure
Nice to have: Bilingual skills
Nice to have: AllScripts Care Management
Nice to have: Milliman Care Guidelines
Nice to have: Interqual

Skills

Vocational Nurse Licensure Acute hospital case management experience Computer/EMR Proficiency

Knowledge of CMS jobs

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