- 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
- Elevance Health (Costa Mesa, CA)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... - 5pm PST, this position includes weekends. The Med Mgmt Nurse is responsible for review of...treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not… 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 ... Facility/Regional - SCMG Operations meetings and task forces.Facilitate regional Utilization Management committees and other working regional… more
- Elevance Health (Los Angeles, CA)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… 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...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
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