- Dignity Health (Bakersfield, CA)
- … management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health ... as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the adverse… more
- Sharp HealthCare (San Diego, CA)
- …for non-approval. Rationale and all supporting documentation are provided to clinical reviewer for final determination.For approvals and denials, documents ... supporting rationale for non-approval. Provides all documentation and rationale to clinical reviewer for final determination. Documentation includes rationale… more
- Humana (Sacramento, CA)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical ...region or line of business. The Medical Director conducts Utilization Management of the care received by… more
- Actalent (Sacramento, CA)
- Utilization Review Nurse (LVN) - InpatientPrimary Responsibilities + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, ... or ambiguous cases to the Medical Director or Physician Reviewer . + Ensure complete, accurate, and compliant documentation aligned...ICU). + At least 1 year of experience in utilization review , case management, or hospital discharge… more
- Sedgwick (Sacramento, CA)
- …related line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and… more
- Alameda Health System (Oakland, CA)
- …to reimbursement, denials management, and non-reimbursed services, promoting effective resource utilization , clinical documentation/queries, quality care and ... contracted vendors. + Responsible for the coordination and support of the AHS Utilization Review Committee. + Responsible for overseeing patient, physician and… more
- Amergis (Orange, CA)
- …Qualifications: + Utilization management reviewer experience. + Managed care experience. + Behavioral health clinical experience. Required Licensure / ... help support a health insurance agency! The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for… more
- Dignity Health (Redwood City, CA)
- …to their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Qualifications** **Minimum Qualifications** **Required ... and Federal and State regulations. The position's emphasis will be on care coordination, communication and collaboration with utilization management, nursing,… more
- Providence (Santa Rosa, CA)
- …with management, medical staff and medical center personnel. Provides payor/ utilization review organizations with concurrent retrospective utilization ... opportunities for advancement. **Requsition ID:** 382655 **Company:** Providence Jobs **Job Category:** Care Management **Job Function:** Clinical Care **Job… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... level of efficiency of operations and customer service while providing quality care to a designated patient population. **Required Qualifications** + Other :… more