- Elevance Health (Costa Mesa, CA)
- …& Analytics (RDA)** + **Cost of Care / Payment Integrity** + **Care Management / Utilization Management (CM/UM) Modernization** + **Provider Networking ... state or territory of the United States when conducting utilization review or an appeals consideration and...or healthcare leadership preferred. + Experience advising medical cost management , utilization management , payment integrity,… more
- Cedars-Sinai (Beverly Hills, CA)
- …management including accounts receivable reconciliation and profit/loss dashboard, regulatory management involving URAC ( Utilization Review Accreditation ... in the Specialty Pharmacy and maintaining compliance with the URAC accreditation ( Utilization Review Accreditation Commission). + Responsible for supervision of… more
- Molina Healthcare (Los Angeles, CA)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... of one or more of the following activities: care review , care management , transition of care, health...statistics including plan utilization , staff productivity, cost-effective utilization of services, management of targeted member… more
- Sutter Health (Roseville, CA)
- …SMCS-Valley Administration **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the ... and at the appropriate level of care. Coordinates the utilization management , resource management , discharge...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- Sutter Health (Roseville, CA)
- …acute care patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the ... case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of… more
- Sutter Health (Burlingame, CA)
- …acute care patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the ... case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of… more
- Sutter Health (Modesto, CA)
- …acute care patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the ... case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of… more
- Stanford Health Care (Palo Alto, CA)
- …Risk Management . **Licenses and Certifications** + CPM - Certified Purchasing Manager (Certification By The Institute For Supply Management ) preferred or + ... LPCH, PCHA, UHA, SBC and new activations as appropriate). The Category Manager is responsible for driving category specific contract coverage and compliance. Areas… more
- Trinity Health (Fresno, CA)
- **Employment Type:** Part time **Shift:** **Description:** This position coordinates utilization review service for defined patient populations across the acute ... care continuum. This includes discharge planning, utilization management , care coordination collaboration, and support for resource utilization . This… more
- Cedars-Sinai (Beverly Hills, CA)
- …years of acute nursing experience required + 3 years of previous experience in case management , discharge planning, utilization review , and HMO in the acute ... oversight of the daily functions of the inpatient case managers. The inpatient case manager conducts case management on patients in the inpatient, and Skilled… more
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