- BrightSpring Health Services (Sacramento, CA)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management Team consisting… more
- CVS Health (Sacramento, CA)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan language… more
- LA Care Health Plan (Los Angeles, CA)
- …Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review . Collaborates with ... Utilization Management Admissions Liaison RN II Job Category:...specific to the case type. Identifies requests needing medical director review or input and presents for… more
- Ventura County (Ventura, CA)
- …+ Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + At ... of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff...care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review … more
- Sharp HealthCare (San Diego, CA)
- …selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations for updating current polices to meet ... and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management, and concurrent and retrospective review … more
- Centene Corporation (Sacramento, CA)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
- Sharp HealthCare (San Diego, CA)
- …selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations. + Participates in the retrospective ... responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management, and concurrent and retrospective rev1ew process.… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more