- Elevance Health (Los Angeles, CA)
- …with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss ... to Medical Director Associates. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical program and/or independently… more
- Stanford Health Care (Palo Alto, CA)
- …area. + Knowledge of basic business aspects of position, such as utilization management , charging practices and regulatory practice compliance. + Knowledge ... for mentorship, education and skill enhancement o Frequent inservices, case studies and journal clubs for continued learning o...a given quarter, exceptions may be granted based on management 's discretion. **This is a Stanford Health Care job.**… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** Under the direction of the Care Management Manager and in collaboration with in interdisciplinary team of Mercy Hospital ... cases; appropriateness of care or level of care / utilization activities; liaison to internal and external contacts /...working with patients and families, chaplains, hospital liaison and case management staff and physicians in assisting… more
- J&J Family of Companies (Los Angeles, CA)
- …Uses product and customer knowledge to present, demonstrate, and ensure proper utilization of products + Customer Relationships: Gain access to the right surgeons ... surgeons, operating room personnel and other pertinent hospital personnel + Case Coverage: Maintainappropriate surgeon/resident contact with all prospects or newly… more
- Molina Healthcare (Long Beach, CA)
- …Coder, Certified Medical Audit Specialists (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional ... Minimum three years clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review. **Required License, Certification, Association**… more
- WelbeHealth (Los Angeles, CA)
- …interdisciplinary team (IDT). The Travel RN Specialist covers any nursing roles (eg, RN Case Manager , RN Clinic Nurse) as needed in multiple markets. The Travel ... of care, participant satisfaction, and to prevent unfavorable outcomes, inappropriate utilization of resources, and unnecessary hospitalizations + Act as the point… more