- Evolent (Sacramento, CA)
- … expertise in developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based models.** ... Process improvement and enhancement of **provider engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited… more
- Humana (Sacramento, CA)
- … care industry, either provider or payer. + Thorough knowledge of health care utilization and quality metrics and the impact value-based contracting has on ... Strategy: + Cultivate and maintain trusted relationships with CMOs and senior executive/ clinical leaders at provider and care delivery partner organizations.… more
- Humana (Sacramento, CA)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... MD or DO degree + 5+ years of direct clinical patient care experience post residency or...region or line of business. The Medical Director conducts Utilization Management of the care received by… more
- Veterans Affairs, Veterans Health Administration (Santa Rosa, CA)
- …of Practice: The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization ... Applying administrative judgment, the use of wide range of clinical flow processes relating to access to care... clinical flow processes relating to access to care across multiple clinical , specialties. Recommends changes… more
- Veterans Affairs, Veterans Health Administration (Ukiah, CA)
- …Learn more Duties and responsibilities of the LVN/LPN include: Performs retrospective medical review of non-VA health care records to determine medical necessity ... record review are present, thereby allowing quick review of inpatient stays by the Clinical ...care . Demonstrates leadership by involving others in improving care . Identifies and assesses resource utilization and… more
- Alameda Health System (San Leandro, CA)
- …by clinical needs, staffing expertise, resource availability/constraints, and a care delivery model that aligns with the overall strategic goals of Alameda ... to patient safety, performance improvement (including pay for performance portfolios), clinical staffing, quality of care , informatics, budget and variance… more
- The County of Los Angeles (Los Angeles, CA)
- …Do you have experience in clinical leadership that influences and progresses clinical care , policy and collaboration in a multidisciplinary setting? + No ... + Consults with the physician as needed to coordinate a plan of care , implement inpatient treatments, review mental assessments, and/or to discuss disease… more
- Elevance Health (Los Angeles, 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 ... and serve as clinical /strategic advisor to enhance clinical operations. May identify cost of care ...reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and… more
- The County of Los Angeles (Los Angeles, CA)
- …Do you have experience in clinical leadership that influences and progresses clinical care , policy and collaboration in a multidisciplinary setting? + No ... and expanded network of community partner clinics - DHS annually provides direct care for 600,000 unique patients, employs over 23,000 employees, and has an annual… more
- Sutter Health (Burlingame, CA)
- …and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care , and observation status. Awareness ... to include the achievement of optimal health, access to care , and appropriate utilization of resources balanced...community resources. When assigned to the Emergency Department, the Care Management process is to address complex clinical… more