- Elevance Health (CA)
- …office visits with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering ... manager . + May be responsible for an entire clinical program and/or independently performs clinical reviews....state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Veterans Affairs, Veterans Health Administration (Fresno, CA)
- …and further refine the rapid housing process at least annually. Establishing huddles, clinical case reviews, and staff meetings with assignments for follow-up ... Program, VISN and VACO. The HUD-VASH Supervisor is responsible for direct Clinical Case Management/referral services in addition to data collection,… more
- Elevance Health (Costa Mesa, CA)
- …or case management experience and requires a minimum of 2 years clinical , utilization review, or managed care experience; or any combination of education ... require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as… more
- Sutter Health (Oakland, CA)
- …Overview:** At the direction of the Manager , Distribution & O/R Materials Manager and the guidance of the Clinical Operation Manager Perioperative ... Communicates back orders and estimated time of arrival to Clinical Operation Manager Perioperative Services . +...of workflow and Materials Programs related to cost savings, utilization and case carts. MAINTAINS AND ENSURES… more
- Elevance Health (CA)
- …+ Requires HS diploma or equivalent. Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and ... ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or… more
- Elevance Health (Walnut Creek, CA)
- …necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer ... ** Clinical Operations Associate Medical Director** **Orthopedic Spine Surgery**...+ Extensive spine surgery experience preferred. + Experience with utilization management, especially with CMS guidelines preferred. + **Orthopedic… more
- Amergis (Orange, CA)
- … Case Manager to help support a health insurance agency! The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and ... and notification of behavioral health services from health professionals, clinical facilities and ancillary providers. The incumbent will be responsible… more
- Sharp HealthCare (San Diego, CA)
- …position is responsible for conducting behavioral health psychosocial assessments and clinical interventions, inclusive of individual, group, and family therapy in ... with the interdisciplinary treatment team, coordinates patient care and provides case management for assigned patients. **Required Qualifications** + Master's Degree… more
- Hospice Of San Joaquin (Stockton, CA)
- …therapists, DME suppliers, and other health care providers in the absence of the case manager to ensure coordination of patient care. JOB QUALIFICATIONS: 1. ... POSITION PURPOSE/SUMMARY: Responsible for the management and delivery of clinical care to patients and families in the HSJ...the Team Leader will handle phone calls from RN Case Managers and assist with care coordination as requested,… more
- ThermoFisher Scientific (Carlsbad, CA)
- …that use IDD instruments. Develop the strategy and the tactics to increase utilization . + Collaborate with the Strategic Account Manager and Strategic Account ... and act on opportunities for growth and optimized lab utilization . The role will act as the primary liaison...customers and improve customer relationships. + Persuasively articulate the clinical and economic case for expanded testing… more