- Elevance Health (CA)
- …services in multiple states. **Preferred Skills, Capabilities, and Experiences:** + Utilization Management experience is strongly preferred. + Health insurance ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… more
- CenterWell (San Diego, CA)
- …performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. ... the delivery of care to all patients served by the location. Receives case referrals. Reviews available patient information related to the case , including… more
- Sharp HealthCare (San Diego, CA)
- …the direction of the manager of in-patient care management and the Director of Utilization Management . **Required Qualifications** + 3 Years Experience ... Bachelor's Degree Health care related field **Other Qualification Requirements** + Utilization , Case Management , or Quality Management certification… more
- Providence (Tarzana, CA)
- …in Healthcare related field (Acute, Ambulatory, Post-Acute, etc.) + 2 years Experience in Case Management (Care Coordination or Utilization Management ) ... care coordination along a continuum through effective transitional care management and utilization management . Recognizing...-by- case basis at each ministry by the Director of Care Management in consultation with… more
- Dignity Health (Bakersfield, CA)
- …as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the ... The position partners with both the Pre-Service and In-Patient Utilization Management teams. Ensures to monitor and...as deemed appropriate. - Identify cases that require additional case management . - Work with appropriate departments… more
- Sutter Health (Oakland, CA)
- …Product Review, oversight of workflow and Materials Programs related to cost savings, utilization and case carts. MAINTAINS AND ENSURES COMPLIANCE OF NATIONAL, ... and controls all operating room inventories utilizing the Lawson Material Management Information Systems. + Initiates and completes ordering of OR Supplies.… more
- Dignity Health (Bakersfield, CA)
- …as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the ... The position partners with both the Pre-Service and In-Patient Utilization Management teams. Ensures to monitor and...as deemed appropriate. - Identify cases that require additional case management . - Composes denial letter in… more
- Tiburcio Vasquez Health Center (Hayward, CA)
- …model that fully integrates primary care, behavioral health, enabling services (eg, case management , health education, outreach), and community resources. + ... improve performance on core metrics, including: + Preventative and Chronic Disease Management . + Risk adjustment, cost, utilization , and value-based performance.… more
- Elevance Health (Costa Mesa, CA)
- …critical thinking skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate ... treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not...about plan benefits and physicians and may assist with case management . + Collaborates with leadership in… more
- LA Care Health Plan (Los Angeles, CA)
- …information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory ... Technician II (12 Month Assignment) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US,...dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all… more