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Use evidence based review guidelines to conduct utilization review as is appropriate to match the payor. For patients who are transitioning to the Skilled Nursing Facilities, refers to nurse practitioner and case manager assigned to the SNF's for continued review and follow up. Ensures appropriate u

The Lead, RN Case Manager is an experienced RN Case Manager who provides clinical and operational support to the Care Management leadership team. In addition to performing the full scope of an RN Case Manager, the Lead is responsible for supporting department operations, conducting audits, reinforci

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity We are looking for a dedicated SIU Manager (P&C). Responsible for operational management of Claims fraud investigative teams. Directs staff in the investigation of cases involving questionable, suspect, or fraudulent activity. Ensures compliance with policies and procedures contributing to fraud control objectives, as well as compliance with state insurance fraud-related laws and regulations. This is a Remote eligible position. However, you must currently live within the State of California. Relocation assistance is not available for this position. What you'll do: • Responsible for insurance fraud detection and investigation services to reduce fraud-related claim payments and costs, while avoiding unwarranted risk., • Ensures compliance with laws and regulations relating to claims handling and unfair claims practices and reporting statutes., • Participates in the establishment and implementation of policies and procedures for fraud control and investigative practices., • Performs leadership and management tasks, i.e., providing coaching, evaluating performance, review of time sheets, managing time off, conducting quarterly check-ins/ride-alongs, etc., • Evaluates, authorizes, and implements actions and decisions to carry out proactive claim’s projects and investigations., • Reviews and evaluates investigation recommendations from investigators to ensure results and case documentation support conclusions., • Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. What you have: • Bachelor’s degree; OR 4+ years of related experience (in addition to the minimum years of experience required) may be substituted in lieu of degree., • 6+ years P&C industry functional work experience OR 4+ years of P&C experience plus military service experience., • 2+ years of demonstrated leadership experience, supervisory or management experience., • Extensive knowledge and experience in all levels of claims investigation or fraud investigation and regulatory reporting requirements., • Knowledge of anti-fraud analytics programs as it relates to fraud prevention and identification., • Thorough understanding of investigative tools and techniques to guide and coach special investigators., • Demonstrated ability to build and maintain collaborative relationships with internal and external partners and business areas., • Demonstrated management skills and the ability to demonstrate monthly productivity and cycle time outcomes from investigations assigned to the SIU team., • Ability to prepare and present training sessions and case outcomes., • Demonstrated experience facilitating and managing projects and teams. What sets you apart: • More than 2+ years of SIU investigator experience, • Current or prior SIU leadership experience managing diverse teams across multiple locations and functions within SIU., • First and Third Party auto and property claims investigations, • SIU or Fraud Investigation Designations (CFE, CIFI, SCLA, etc.,)., • Demonstrated experience in leveraging business data to inform decision making and drive strategy., • US military experience through military service or a military spouse/domestic partner Compensation range: The salary range for this position is: $114,080 - $218,030 USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, F-1, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com. Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Pay Package: Total weekly gross $ 2979 for 40 hrs.Location: Mission Hills, CA 91345.Weekend Requirements: Every other weekend.Must have acute care experience.For more details, please reach out to Vidya.For a quick reply call/text on (703) 480-4121.

Adventist Health is seeking a Registered Nurse (RN) Care Manager for a nursing job in West Los Angeles, California. Collaborates with acute care case managers to ensure appropriateness on on-going care. Posted job title: care manager (rn), ahwm montebello site.

Providence Holy Cross Medical Center.We at Bestica believe our success is a direct result of hard work and outstanding employee dedication.Our environment is dynamic, friendly, and collaborative.We foster a positive culture, where innovation and synergy are encouraged to build our workplace into a c

A Registered Nurse Case Manager (RN Case Manager) is a licensed nursing professional who coordinates and oversees patient care across the healthcare continuum. RN Case Managers assess patient needs, develop individualized care plans, and facilitate communication between patients, families, providers

Minimum 2 years acute medical Care Manager experience performing Care Coordination/Discharge Planning.

A Field Case Manager role is a home-based position with travel, up to 2 hours one-way, to doctors' offices, hospitals, and various other locations. The Case Manager works with insurance carriers, medical care providers, attorneys, employers, and employees, and closely monitors the progress of the in

TravelNurseSource is working with Host Healthcare to find a qualified Case Manager RN in Palo Alto, California, 94304!. Registered Nurse (RN) | Case Manager. Host Healthcare is an award-winning travel healthcare company with an immediate opening for this Registered Nurse - Case Management in Palo Al

We're hiring a RN Case Manager - a compassionate and skilled clinician who coordinates care, develops individualized plans, and provides hands-on hospice and palliative care for patients and families. Perform field case management and other duties assigned.

Lancesoft is seeking an experienced Case Manager Registered Nurse for an exciting Travel Nursing job in Los Angeles, CA.

Registered Nurse (RN) | Case Manager. TravelNurseSource is working with KPG Healthcare to find a qualified Case Manager RN in Santa Monica, California, 90401!. KPG Healthcare is currently seeking an experienced Case Management Registered Nurse for a travel assignment.

IDR Healthcare is seeking a travel nurse RN Case Management for a travel nursing job in Los Angeles, California.

At Centinela Hospital Medical Center, our dedicated team of professionals are committed to our core values of quality, compassion, and community.As a member of Prime Healthcare, a Top-15 hospital system in the United States, Centinela Hospital Medical Center is actively seeking new members to join i

Registered Nurse (RN) | Case Manager. TravelNurseSource is working with KPG Healthcare to find a qualified Case Manager RN in Irvine, California, 92650!. Travel Case Management Registered Nurse (RN) - 2407 per week in taxable pay and non-taxable stipend amount.

CSMN - 8714015 - Inpatient Specialty Program Crisis Response.We at Bestica believe our success is a direct result of hard work and outstanding employee dedication.Our environment is dynamic, friendly, and collaborative.We foster a positive culture, where innovation and synergy are encouraged to buil

As an RN Case Manager you will be responsible for the coordination and implementation of case management strategies pursuant to the Case Management Plan. Minimum of two (2) years of case management experience or Three (3) years of acute hospital experience, will accept 1st time Traveler if coming fr

NuWest Travel Nursing is seeking a travel nurse RN Outpatient Care Manager for a travel nursing job in Los Angeles, California. Coordinate support for patients and community care sites. Case management or community care experience preferred.

Wesley Health Centers is a private non-profit health agency that is working towards increasing access to high quality health care resulting in decreased health disparities among at-risk populations through the expansion of comprehensive and preventative health care programs and services. Our mission

Facilitates peer to peer discussions between attending physicians, Case Management Consultants, and Physician Advisor in cases requiring evaluation and justification of medical necessity for admission by the payer. The Case Manager is accountable for a designated patient caseload and plans effective

The nurse (RN) case manager/care coordination team leader has the responsibility to manage all PACE participants in the ambulatory setting. A minimum of 1 year of experience is preferred in a managed care setting, preferably in utilization or case management in an ambulatory or inpatient setting. Af

Using the agreed upon learning objectives, outcomes, and goals, provides the new hire, the education team, the quality team, and the manager with an objective evaluation of the new hire's clinical performance throughout and at the conclusion of the orientation process. Completes the preceptor-precep

Assisted is looking for a per diem Hospice RN for our Los Angeles branch to pick up 6-9 visits per week across our Los Angeles territory.Admission- $200 per visit + $11 for mileage.Routine- $70 per visit + $11 for mileage.Weekday waiting to engage rate- $50 per day.Weekend waiting to engage rate- $1

LanceSoft is seeking a travel nurse RN Acute Care Case Management for a travel nursing job in Mission Hills, California. Job Description & Requirements Specialty: Acute Care Case Management Discipline: RN Start Date: 03/23/2026 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel RN – Case Manager Providence Holy Cross Medical Center | Mission Hills, CA Duration: 13 weeks Shift: Days, 5×8 (8:00 AM–4:30 PM) Requirements: 2 years acute care hospital Case Manager experience (care coordination discharge planning) Experience using Epic Travel experience (1st-time travelers considered) Knowledge of InterQual, discharge planning, DME/SNF placement, HMO/IPA processes CA RN license (pending accepted if active by start) Unit Info: Ratios: 1:20 Weekend rotation required Patients: Adolescents, Adults, Geriatrics Support from Social Services & Transportation Must be proficient with computerized documentation & Microsoft applications About LanceSoft Established in 2000, LanceSoft is a Certified MBE and Woman-Owned organization. Lancesoft Inc. is one of the highest rated companies in the industry. We have been recognized as one of the Largest Staffing firms and ranked in the top 50 fastest Growing Healthcare Staffing firms in 2022. Lancesoft offers short- and long-term contracts, permanent placements, and travel opportunities to credentialed and experienced professionals throughout the United States. We pride ourselves on having industry leading benefits. We understand the importance of partnering with an expert who values your needs, which is why we’re 100% committed to finding you an assignment that best matches your career and lifestyle goals. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.LanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities. Benefits Weekly pay Medical benefits

Under the general supervision of the CM Director the nurse case manager manages clinical resource utilization and documentation affecting reimbursement, acting as a resource to staff and physicians in resource efficiencies and documentation that affects reimbursement. In this position the case manag

Mental Health America of Los Angeles (MHALA) has been a pioneer in mental health service, advocacy, innovation, and training for nearly a century, working to ensure that people with mental health needs achieve meaningful, healthy lives in their communities. MHALA is among the largest and most compre

The Case Manager will provide clinical case management services to a caseload of up to 25 Veterans enrolled in the HUD-VASH program. Case Manager - Master's Degree. STGi is currently seeking qualified Case Manager candidates for the Department of Housing and Urban Development (HUD) and Veterans Affa

Once Clients locate best-fit housing, The Case Manager works to implement interventions with. The Case Manager collaborates with Clients to learn independent living skills and other life-skills vital to successful transition from homelessness into permanent housing. Maintain a caseload of approximat

Maintain confidentiality of Client information per HIPAA and internal agency guidelines. We select the most qualified individual for the job basedon job-related qualifications regardless of race, color, age, sex, religion, national origin, disability, ancestry, marital status, credit history, sexual

This is a temporary position for 3 months with possible extensions. Provide support throughout the housing process including but not limited to temporary housing placement, unit identification, application submissions, lease signing, and ongoing housing retention.

The Mental Health Counselor II provides a range of services as part of the treatment team. Mental Health Counselor acts as a case manager and may conduct individual/group rehabilitation, collateral services, and linkage to formal and informal resources. Is expected to become familiar and establish r

Case Manager - Eviction Defense Center Workgroup.Continuous until position is filled.Are you interested in joining an organization dedicated to increasing access to justice while addressing systemic inequities among the most vulnerable members of the Greater Los Angeles area? If yes, LAFLA is the pl

To succeed as the LCSW Case Manager Supervisor, you should have:. Your responsibilities as the LCSW Case Manager Supervisor will include:. Lead, supervise, and performance-manage ECM Care Managers, establishing KPIs aligned with CalAIM quality metrics, productivity standards, and outcomes-driven car

We are seeking a Registered Nurse to join our team.In this role, you will primarily be creating and managing a plan of care for individual patients.You are a Registered Nurse (RN) who operates with great attention to detail and a big heart.You take pride in creating personalized care plans for patie

Plans, organizes, and directs home care services and is experienced in nursing, with emphasis on community health education/experience.The professional nurse builds from the resources of the community to plan and direct services to meet the needs of individuals and families within their homes and co

Behavioral Health Case Manager I. Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Behavioral Health Case Manager I.

We are seeking an experienced Case Manager to join our team! As a Case Manager with us, you will be guiding clients through a variety of life struggles, both in their personal and professional lives. Manage an evolving caseload of clients with a variety of issues and concerns.

Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred. Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other ac

Amity Foundation is a safe place where people can change in an environment that fosters trust; where new values can be formed; responsibility developed, and lasting relationships built.

Case Manager II to provide comprehensive support to veterans overcoming housing instability, trauma, mental health challenges, and other barriers to long-term stability.

Under the general supervision of the Milestones Program Manager, the Mental Health Clinician I is responsible for providing comprehensive onsite, and field based, mental health, case management, individual crisis intervention and supportive counseling with intensive case management. Co-Occurring Che

Watch this short video for a brief introduction to role of a nurse case manager at Paradigm. A Field Case Manager role is a home-based position with travel, up to 2 hours one-way, to doctors' offices, hospitals, and various other locations. The Case Manager works with insurance carriers, medical car

Registered Nurse (RN) | Case Manager. TravelNurseSource is working with TRS Healthcare to find a qualified Case Manager RN in Oakland, California, 94609!. Registered Nurse - Case Management.

One of our clients is seeking a experienced Case Manager to work in their Pre-Litigation Personal Injury plaintiff's firm. This is a very team oriented environment to assist with every step of the case.

Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning. Remains current from a knowledge base perspective regarding reimbursem

Personal Injury Case Manager - Full-time. Prior experience in case management. A challenging, fast-paced, and interesting caseload!.

The Emergency Response Case Manager provides intensive case management, client support, and crisis intervention to survivors of human trafficking and modern-day slavery. Provide survivor-driven, client-centered, timely, and professional case management for domestic and foreign national victims of hu