• Director Of Nursing / DON / 10k Sign On

    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
    BrightSpring Health Services (08/16/25)
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  • Supv Regional Care Mgmt - Integrated Care…

    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 ... Facility/Regional - SCMG Operations meetings and task forces.Facilitate regional Utilization Management committees and other working regional… more
    Sharp HealthCare (07/09/25)
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  • Director , Utilization

    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
    Alameda Health System (08/08/25)
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  • Director of Case Management

    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
    Prime Healthcare (08/26/25)
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  • Utilization Management Admissions…

    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
    LA Care Health Plan (08/02/25)
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  • LVN - Utilization Management - SRS…

    Sharp HealthCare (San Diego, CA)
    …**90 days** **of in-person training.** **What You Will Do** To provide comprehensive utilization management and coordination of care for SRS Members. Ensure ... be unrestricted. **Essential Functions** + Referral CoordinationEnsures consistent application of the utilization review process for effective utilization of… more
    Sharp HealthCare (08/29/25)
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  • Medical Director , Ventura County Health…

    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
    Ventura County (08/04/25)
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  • Senior Medical Director - Sharp Health Plan…

    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
    Sharp HealthCare (07/19/25)
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  • Field Medical Director , Pain…

    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
    Evolent (08/20/25)
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  • Director , Inpatient System Care…

    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
    Alameda Health System (08/08/25)
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