- Humana (Sacramento, CA)
- …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Sacramento, CA)
- …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... with prior experience participating in teams focusing on quality management , utilization management , case ...business metrics. + Experience working with Case managers or Care managers on complex case management , including… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds...needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care . **DUTIES… more
- Prime Healthcare (Inglewood, CA)
- …Social Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure ... part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our...patiens receive timely, appropriate, and efficient care throughout their hospital stay. The Director … more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...Management or CM. Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid… more
- LA Care Health Plan (Los Angeles, CA)
- …of work/licensure. The Supervisor is a subject matter expert (SME) in Care /Case/ Utilization Management and supporting regulations, policies, protocols, and ... 's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists UM Educator/Manager/ Director ... experience. Minimum of 2 years of experience in Case/ Care / Utilization Management in an acute… more
- Sharp HealthCare (San Diego, CA)
- …of** **90 days** **of in-person training.** **What You Will Do** To provide comprehensive utilization management and coordination of care for SRS Members. ... or clinical setting. + 2 Years utilization /Case Management experience, preferably in a Managed Care ...necessity are issued under the direction of the Medical Director or designee. + Data and documentation collectionGather relevant,… more
- Ventura County (Ventura, CA)
- …communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... Medical Director , Ventura County Health Care Plan...procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval… more
- CVS Health (Sacramento, CA)
- …Review nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists management with training new ... with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we...3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management… more
- Alameda Health System (Oakland, CA)
- Director , Inpatient System Care Management + Oakland, CA + Highland General Hospital + SYS Care Coordination + Full Time - Varies + Management + Req ... hiring! Under the direction of the Vice President of Care Management , the Director of...including cost of care to reimbursement, denials management , and non-reimbursed services, promoting effective resource utilization… more
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