- Alameda Health System (Oakland, CA)
- …outpatient). 3. Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity criteria. ... of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in appropriate… more
- Sutter Health (Sacramento, CA)
- …of health care services. The PA meets with care management, UM staff and health care team members and medical directors of third-party payers to discuss the ... act as a liaison between the CDI (Clinical Documentation Improvement) professional, HIM ( Health Information Management ) ,and the hospital's medical staff to… more
- Sutter Health (Sacramento, CA)
- … review /discharge planning services appropriate to patients with complex medical , emotional and social needs. + Excellent interpersonal skills and time ... We are so glad you are interested in joining Sutter Health ! **Organization:** SCP-Sutter Center for Psychiatry **Position Overview:** The Utilization Review… more
- The County of Los Angeles (Los Angeles, CA)
- …staff training is needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to ... CA Job Type Full time Job Number Y5125L Department HEALTH SERVICES Opening Date 05/21/2025 + Description + Benefits...year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.**… more
- Tiburcio Vasquez Health Center (Hayward, CA)
- …to develop and adapt to the evolving technological requirements of modern medical health center practices required. + Demonstrates flexibility regarding job ... (CNM, NP or PA) to provide clinical leadership and oversight for our Women's Health department. Reporting directly to the Chief Medical Officer (CMO), the AMD… more
- Elevance Health (Walnut Creek, CA)
- **Behavioral Health Medical Director- Child Psychiatrist** Location: This role enables associates to work virtually full-time, with the exception of required ... Fulltime position, Monday through Friday. Open to part-time. The **Behavioral Health Medical Director- Child Psychiatrist** is responsible for completing… more
- Prime Healthcare (Ontario, CA)
- …phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews ... members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization ...and appeals. Document and track all communication attempts with insurance providers and health plans and scan… more
- Elevance Health (Walnut Creek, CA)
- **Behavioral Health Medical Director-Psychiatrist Appeals** **Location:** California. This role enables associates to work virtually full-time, with the ... Director** is responsible for the administration of behavioral health medical services, to ensure the appropriate...with attending physicians or other ordering providers to discuss review determinations. + Serves as a resource and consultant… more
- Prime Healthcare (Ontario, CA)
- …phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews ... members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization ...and appeals. Document and track all communication attempts with insurance providers and health plans and scan… more
- Centene Corporation (Sacramento, CA)
- …per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance , 401K and stock purchase plans, tuition reimbursement, paid ... 28 million members as a clinical professional on our Medical Management/ Health Services team. Centene is a...efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical … more
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