- Elevance Health (Costa Mesa, CA)
- …critical thinking skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate ... about plan benefits and physicians and may assist with case management . + Collaborates with leadership in...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- Amergis (Orange, CA)
- …Medical Case Manager to help support a health insurance agency! The Medical Case Manager (BHI Utilization Management ) will be responsible for reviewing ... as those listed above may also be qualifying. Preferred Qualifications: + Utilization management reviewer experience. + Managed care experience. + Behavioral… more
- Elevance Health (CA)
- …Washington Medicaid operations by providing clinical leadership and oversight across utilization management , appeals, and program innovation. This position ... and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Tiburcio Vasquez Health Center (Hayward, CA)
- …model that fully integrates primary care, behavioral health, enabling services (eg, case management , health education, outreach), and community resources. + ... improve performance on core metrics, including: + Preventative and Chronic Disease Management . + Risk adjustment, cost, utilization , and value-based performance.… more
- The County of Los Angeles (Los Angeles, CA)
- …psychotherapeutic methods include group, family, individual and conjoint therapy, clinical case management , and crisis intervention. Positions allocable to this ... or emotional problem, which may include individual, group, family or marital counseling, case management , and/or referral to another treatment source such as a… more
- The County of Los Angeles (Los Angeles, CA)
- …opinion or advice of a physician whenever the incumbent determines if a case falls outside the scope authorized by policies and protocol. The Nurse Practitioner ... or to specialized health resources for treatment but retains responsibility for clinical management as well as any subsequent modification. Incumbents may review … more
- Sharp HealthCare (La Mesa, CA)
- …with the interdisciplinary treatment team, coordinates patient care and provides case management for assigned patients. **Required Qualifications** + Master's ... in a behavioral health setting + Acute/psychiatric hospital experience, discharge planning/ case management experience **Essential Functions** + Communication and… more
- US Marine Corps (Twentynine Palms, CA)
- …flow studies, work processes, reviews and improvement studies to provide management with recommendations for optimum utilization of available resources. ... Formulates and develops training, policies, and procedures for office management . Coordinates with Division leadership on responsible administrative efforts, and… 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 ... Capabilities and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience.… more
- Providence (Napa, CA)
- **Description** Social Worker MSW in Utilization Review Unit at Queen of the Valley Medical Center, CA. This position is Full time and will work 8-hour Day ... compassionate service. Under minimal supervision and at the direction of the Case Management Director, the Inpatient Social Worker/Patient Counselor is… more