- Highmark Health (Sacramento, CA)
- …drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide recommendations for NDC ... not limited to: prior authorization, dose and duration edits, quantity limits, step- care edits, generic sampling medical policy review and development, member… more
- The County of Los Angeles (Los Angeles, CA)
- …techniques and methodologies to analyze large-scale service utilization data (eg, service utilization by CPT codes, level of care , and provider type, and ... to make better financial, business, policy and operational decisions in managing costs, utilization , and quality of care as well as financial risk management.… more
- Cedars-Sinai (Beverly Hills, CA)
- …+ Processes Extensions and Denial Letters, when needed. + Prepares Utilization Review Reports as needed. + Assists the Case/ Care Managers in coordinating and ... **Job Description** The Case Management Coordinator provides support to the utilization review process. The coordinator works collaboratively with all team… more
- Cherry Bekaert (Sacramento, CA)
- …Resource Coordinator will effectively fill resource engagement requests overseeing the utilization of resources, ensuring alignment of resources with the strategic ... at least 100 people with minimal oversight from a manager . + Collaborate with engagement teams to understand their...trusted business advisor for service leads. + Generate scheduling, utilization and forecasting reports and provide analysis of the… more
- Genesis Healthcare (Elk Grove, CA)
- …department, including oversight related to case management, quality improvement, care planning, clinical utilization , and patient identification is ... assisted and independent living facilities, outpatient clinics, and home-based care . We're proud to deliver personalized care ...or coordinating the timely completion of the annual merit review for therapy staff. 6. Assists in management of… more
- Elevance Health (Walnut Creek, CA)
- …Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners ... information presented meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review of exception… more
- Elevance Health (CA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... Medicaid operations by providing clinical leadership and oversight across utilization management, appeals, and program innovation. This position ensures timely,… more
- Elevance Health (CA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to… more
- KBR (Coronado, CA)
- …as assigned by the HP program Manager and/or Coordinator. + Document care provided, work performed, utilization , referrals, and all other information in the ... scope of practice. + Participate in periodic meetings to review the care provided to patients and...+ Serve as an advisor to the HP program Manager and/or Coordinator in matters related to injury prevention,… more
- Elevance Health (Walnut Creek, CA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to… more