- Ventura County (Ventura, CA)
- …that establish, expand, and maintain the pool of eligible service providers. + Utilization review : + Uses professional skills in quality management activities ... Type Full-Time Regular Job Number 0343HCA-25AA (VM) Department Health Care Agency Division Behavioral/Mental Health Opening Date 05/02/2025 Closing...such as utilization review , monitoring and evaluation procedures, and… more
- The County of Los Angeles (Los Angeles, CA)
- …standards of care and establishes and modifies program monitoring and review methods as necessary. + Oversees audits and the implementation of audit ... nurses, psychiatric social workers, marriage and family therapists, medical doctors, clinical case managers, and/or other mental health care professionals… more
- Novo Nordisk (San Diego, CA)
- About the Department The Clinical , Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... Affairs (FMA), this position has primary responsibility for directing clinical engagement efforts and developing/implementing medical account strategies on behalf… more
- Alameda Health System (San Leandro, CA)
- …staff, visitors, and volunteers. 8. Assures that the facility complies with all utilization review and case management requirements of Alameda County, AHS, and ... responsible for the coordination and oversight of all medical care provided at the hospital and is identified as...works with department Lead Physicians to oversee providers and clinical personnel who report to them and have responsibility… more
- Sedgwick (Sacramento, CA)
- …narcotic use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, ... and experience required to include three (3) years of recent clinical practice experience. Utilization practice experience preferred. Insurance/claims industry… more
- Evolent (Sacramento, CA)
- …experience and as an RN - **Required** + Minimum of 5 years in Utilization Management, health care Appeals, compliance and/or grievances/complaints in a quality ... people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care … more
- Providence (Napa, CA)
- … Care **Job Schedule:** Full time **Job Shift:** Day **Career Track:** Clinical Professional **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa ... **Description** Social Worker MSW in Utilization Review Unit at Queen of...heart & kidney failure, hip fracture, stroke, and maternity care . Our dedication to the highest standards of patient… more
- City and County of San Francisco (San Francisco, CA)
- …process; and prepares written care summaries for the purpose of coordinating care ; + Performs clinical evaluations in the more difficult individual cases by ... Housing and the Department of Public Health can then review your application and contact you directly with details...advocacy, community organization, and interviewing techniques. + Knowledge of clinical methods refers to the utilization of… more
- Elevance Health (Walnut Creek, CA)
- …of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer consultation ... ** Clinical Operations Associate Medical Director** **Orthopedic Spine Surgery**...practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging… more
- Sharp HealthCare (La Mesa, CA)
- …employer business practices. **What You Will Do** To provide the professional, clinical and technical knowledge, skills and expertise required for the provision of ... comprehensive pharmaceutical care that supports the mission, values and philosophy of...90 days of hire. **Essential Functions** + Verification and review of medication ordersReviews all medication orders for appropriate… more