- Dignity Health (Bakersfield, CA)
- …Gathering all information needed to make a determination and/or coordinate with the Medical Director as needed. - Responsible to coordinate with contracting to ... for accessibility within the network. - Consults with the medical director on cases that do not...information, PHI and HIPAA regulations. **Preferred Qualifications:** - Prior Utilization Management ( UM ) experience strongly preferred. -… more
- Evolent (Sacramento, CA)
- …LCSW, and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point...also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
- LA Care Health Plan (Los Angeles, CA)
- …admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires ... net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons...logs and other sources. + Achieves and maintains benchmarked utilization and cost management ( UM ) goals and… more
- Sharp HealthCare (San Diego, CA)
- …as a physician executive in a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical ... + Provides professional leadership and direction to the functions within the Medical Management + Department ( Utilization /Cost Management and Quality Management)… more
- Elevance Health (Los Angeles, CA)
- ** Medical Director -PSCCR** Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... an accommodation is granted as required by law. The ** Medical Director -PSCCR** is responsible for the administration...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- UCLA Health (Los Angeles, CA)
- …lead the development, evaluation, and implementation of multiple clinical programs and medical services with an emphasis on optimizing Utilization Management for ... will: + Oversee the development and execution of multiple UM processes and workflows, while continuously identifying and evaluating...years of executive leadership experience with a focus on Utilization Management for a medical group, IPA,… more
- Dignity Health (Bakersfield, CA)
- **Responsibilities** This position is remote.** **Position Summary:** The Director of Provider Contracting is a key executive leader responsible for the strategic ... the full contract lifecycle for physicians, facilities, and ancillary providers. The Director plays a pivotal role in maximizing clinical, financial, and experience… more
- Sharp HealthCare (San Diego, CA)
- … medical management activities to include tracking, trending and analyzing UM data. Works in collaboration with regional medical directors, ambulatory ... under the direction of the manager of in-patient care management and the Director of Utilization Management. **Required Qualifications** + 3 Years Experience in… more