- Actalent (Santa Barbara, CA)
- …management , Case management , Utilization management , Claim Top Skills Details Data entry,Concurrent review ,Prior authorization,Health ... and health services team members in the implementation and management of Utilization Management , Case Management , Disease Management , Population… more
- Sharp HealthCare (San Diego, CA)
- …performance-planning, competency and individual development planning process.Maintain current knowledge of case management , utilization management , and ... Board of Registered Nursing; Accredited Case Manager (ACM) - American Case Management Association (ACMA); Master's Degree; Bachelor's Degree in Nursing… more
- Stanford Health Care (Palo Alto, CA)
- …a combination of remote and onsite as scheduled. Whether this would be your first case management role or you are seasoned, here is your opportunity to work ... include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review ...the delivery and quality of patient care. A hospital-based case management system has as its primary… more
- Cedars-Sinai (Marina Del Rey, CA)
- …the established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review for ... and continuing care. + Assumes responsibility for timely completion of required case management reports for regulatory bodies, health plans, and insurance… more
- Rising Medical Solutions (Los Angeles, CA)
- …of the following specialties: industrial rehabilitation nursing, medical case management , occupational health, orthopedics, home health care, utilization ... of dedicated professionals committed to elevating the standards of medical case management for workplace injuries and find a collaborative environment where your… more
- Sharp HealthCare (San Diego, CA)
- …in risk management reviews. + Assists in pharmacy utilization management , catastrophic case review , outreach programs, HEDIS reporting, site visit ... to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management , and concurrent...with the Quality Improvement Director. + Assists in POS/PPO Case Management and high-cost review … more
- Sharp HealthCare (San Diego, CA)
- …non-physician health care practitioners involved in Admission & Triage, Discharge planning, and case management of chemical dependency patients. + AHA Basic Life ... when not in use.Is knowledgeable of current laws and regulations regarding Utilization Review and Discharge Planning.Morning arrival time insures orderly… more
- Sharp HealthCare (San Diego, CA)
- …process. + Participates in risk management , pharmacy utilization management , catastrophic case review , outreach programs, HEDIS reporting, site ... and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management , and concurrent and retrospective rev1ew… more
- Sutter Health (Goleta, CA)
- …- Santa Barbara **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's accepted ... and at the appropriate level of care. Coordinates the utilization management , resource management , discharge...A broad knowledge base of health care delivery and case management within a managed care environment.… more
- Elevance Health (Walnut Creek, CA)
- …managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of education ... critical thinking skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate… more