- Humana (Sacramento, CA)
- …Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** : ... part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical… more
- Actalent (Redlands, CA)
- …internal staff to ensure seamless care coordination. Essential Skills + Utilization review and management experience. + Familiarity with Medicare, MediCal, ... Job Title: Remote LVN Case Manager - Utilization Management Job Description Join our dynamic ...LVN Case Manager where you will assess requests against clinical guidelines and effectively communicate decisions to providers and… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patiens receive… more
- CenterWell (Sacramento, CA)
- … clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + ... and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- Prime Healthcare (Chino, CA)
- …for its quality, including as among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. ... Medical Center is committed to serving the community's health care needs with top-rated emergency care as...designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a… more
- Prime Healthcare (San Dimas, CA)
- …technology, we are committed to serving the community with personalized, high-quality care . We offer a full range of comprehensive services, including 24-hour ... their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting...designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a… more
- Prime Healthcare (Anaheim, CA)
- …Founded in 1964, West Anaheim Medical Center is a 219-bed acute- care hospital dedicated to providing the community with high-quality, compassionate healthcare. ... Key services include general medical and surgical inpatient care and treatment, emergency services, surgical services, behavioral health, comprehensive heart center,… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Enhanced Care Management Clinical Specialist II Job...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- Centene Corporation (Sacramento, CA)
- …were administered with quality, cost efficiency, and are within compliance. + Performs a clinical review of post- care services by reviewing medical records ... Remote Role, California RN Licensing Highly Preferred **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine… more
- Centene Corporation (Sacramento, CA)
- …a current CA license.** **Must have** **2-4 years related** **experience in UM-Concurrent Review . 2+ years of acute care experience required. 10% Travel ... findings + Assists with providing education to providers on utilization processes to ensure high quality appropriate care...to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical … more