- Evolent (Sacramento, CA)
- …business needs of the particular health plan. * Research requests for post-determination review and categorizes each for processing based on the applicable ... You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Ventura County (Ventura, CA)
- …service fee rates based on analysis of complex cost components, past utilization trends and impact on fund balances or retained earnings. + Learns to compile, ... completion of a graduate degree. + Bilingual Incentive - Based on agency need, proficiency levels by exam are...The County includes 42 miles of coastline which is home to the fol-lowing cities and points of interest:… more
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... appropriate plan is developed enabling a patient to go home , or facilitates the relocation of the patients to...Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical… more
- Sharp HealthCare (San Diego, CA)
- …when not in use.Is knowledgeable of current laws and regulations regarding Utilization Review and Discharge Planning.Morning arrival time insures orderly ... + Data collectionParticipates in data and statistics collection as requested by Utilization Review , Service Line and Quality Improvement Committees. + Denial… more
- Humana (Sacramento, CA)
- …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
- Humana (Sacramento, CA)
- …this knowledge in their daily work. The Medical Director's work includes computer- based review of moderately complex to complex clinical scenarios, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
- Humana (Sacramento, CA)
- …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
- Genesis Healthcare (Carmichael, CA)
- …skilled nursing centers, assisted and independent living facilities, outpatient clinics, and home - based care. We're proud to deliver personalized care exactly ... and thrive while providing essential therapy for children at home and in school. With over 38 years of...Director in the timely completion of the annual merit review for therapy staff. 7. Assists Clinical Operations Area… more
- Humana (Sacramento, CA)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Dignity Health (Rancho Cordova, CA)
- …position is hybrid in-office/clinic (Rancho Cordova and Woodland) and work from home .** **Position Summary:** Under the guidance and supervision of the department ... Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic… more