- Evolent (Sacramento, CA)
- …training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. ... requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business… more
- The County of Los Angeles (Los Angeles, CA)
- …welfare eligibility determination, appeals investigation, quality auditing, fraud investigation, or GAIN case management . OPTION 2: Four years of experience in a ... making recommendations to line managers on matters such as: utilization of personnel, allocation of funds, workload and workload...Investigation + Quality Auditing + Fraud Investigation + GAIN Case Management + None of the Above… more
- Sutter Health (Oakland, CA)
- …Product Review, oversight of workflow and Materials Programs related to cost savings, utilization and case carts. MAINTAINS AND ENSURES COMPLIANCE OF NATIONAL, ... Health! **Organization:** ABSMC-Ashby Campus **Position Overview:** At the direction of the Manager , Distribution & O/R Materials Manager and the guidance of… more
- Elevance Health (Walnut Creek, CA)
- …of 4 years managed care experience and requires a minimum of 2 years clinical, utilization review, or case management experience; or any combination of ... critical thinking skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate… more
- Elevance Health (Sacramento, CA)
- …individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management , or similar role; or any combination of ... Service Coordinator - RN Clinician** is responsible for overall management of member's case within the scope...co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and… more
- Genesis Healthcare (Elk Grove, CA)
- …of the rehabilitation department, including oversight related to case management , quality improvement, care planning, clinical utilization , and patient ... is responsible for assisting the Director of Rehab in the efficient management of rehabilitation services in his/her assigned account(s). This position also assists… more
- LA Care Health Plan (Los Angeles, CA)
- …staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an ... Technician II (12 Month Assignment) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US,...dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all… more
- Huntington Ingalls Industries (Port Hueneme, CA)
- …abilities, strategic thinking, and a deep understanding of defense industry contract management practices. As the Program Manager , you will be responsible ... Range: $144,384.00 - $200,000.00 Security Clearance: Secret Level of Experience: Management This opportunity resides with Global Security (GS). Mission Technologies'… more
- Edwards Lifesciences (Los Angeles, CA)
- …**How you will make an impact:** + Working independently in the areas of valve crimping, case management , pre- case planning, post- case management , 3 ... Mensio management , Therapy Awareness program management and clinical education programs. + Implementing sales and...educational material during training sessions in order to drive utilization of the Edwards's THV product portfolio. + Utilizing… more
- Sharp HealthCare (San Diego, CA)
- …discrepancies or errors are identified, recommend changes as needed to internal case manager /staff.Ensures that documentation relative to IRF-PAI is maintained ... Requirements** + IRF PPS Certification required within 1 year of hire date. Management to track and maintain this certification - REQUIRED **Essential Functions** +… more