- 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...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
- Prime Healthcare (Inglewood, CA)
- …provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patiens… more
- CVS Health (Sacramento, CA)
- …Nurse (RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must ... nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists management with training new nurse… more
- LA Care Health Plan (Los Angeles, CA)
- …with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review . Collaborates with ... Utilization Management Admissions Liaison RN II... Utilization Management Admissions Liaison RN II Job Category: Clinical...specific to the case type. Identifies requests needing medical director review or input and presents for… more
- Ventura County (Ventura, CA)
- …and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
- Sharp HealthCare (San Diego, CA)
- …visits and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management , and concurrent and retrospective ... risk management reviews. + Assists in pharmacy utilization management , catastrophic case review ,...Improvement Director . + Assists in POS/PPO Case Management and high-cost review with CMO and… more
- Evolent (Sacramento, CA)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Alameda Health System (Oakland, CA)
- …contracted vendors. + Responsible for the coordination and support of the AHS Utilization Review Committee. + Responsible for overseeing patient, physician and ... Director , Inpatient System Care Management +...financial analyses including cost of care to reimbursement, denials management , and non-reimbursed services, promoting effective resource utilization… more
- Sharp HealthCare (San Diego, CA)
- …and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management , and concurrent and retrospective rev1ew ... a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical...process. + Participates in risk management , pharmacy utilization management , catastrophic case review ,… more
- Centene Corporation (Sacramento, CA)
- …of Certifying Board Service (Internal and Family Medicine, preferred) + Utilization Management experience and knowledge of quality accreditation standards. ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more