- Centene Corporation (Sacramento, CA)
- …physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of ... management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality… more
- LA Care Health Plan (Los Angeles, CA)
- …and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The ... $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created...RN experience. At least 3 years of experience in utilization management or clinical coding. Investigation and/or… more
- Dignity Health (Los Angeles, CA)
- …hire. + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure progression ... and Federal and State regulations. The position's emphasis will be on care coordination, communication and collaboration with utilization management, nursing,… more
- Dignity Health (Long Beach, CA)
- …card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure progression ... and Federal and State regulations. The position's emphasis will be on care coordination communication and collaboration with utilization management nursing… more
- Dignity Health (Glendale, CA)
- …card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure progression ... and Federal and State regulations. The position's emphasis will be on care coordination, communication and collaboration with utilization management, nursing,… more
- Dignity Health (Long Beach, CA)
- …card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure progression ... and Federal and State regulations. The position's emphasis will be on care coordination, communication and collaboration with utilization management, nursing,… more
- Sharp HealthCare (Santee, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... **Preferred Qualifications** + 1 Year LVN experience in related clinical area + Ambulatory care experience +...Follows policy and procedure for entering of OCM and utilization of IDX. Completes work within assigned hours.Able to… more
- Sharp HealthCare (San Diego, CA)
- …the ability to combine clinical /quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving care in the ... care . The position creates a balance between individual clinical needs with the efficient and cost-effective utilization...provides information to the department head as indicated. + Utilization review and utilization managementThe… more
- Sutter Health (Roseville, CA)
- …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. If assigned to the Emergency Department, the Care Management process is to address complex clinical… more
- Sutter Health (Modesto, 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. If assigned to the Emergency Department, the Care Management process is to address complex clinical… more