- Humana (Sacramento, CA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Sacramento, CA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- LA Care Health Plan (Los Angeles, CA)
- …vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where ... Utilization Management Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... Generous paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing… more
- Prime Healthcare (Inglewood, CA)
- …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patiens ... ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations… more
- Sharp HealthCare (San Diego, CA)
- …**90 days** **of in-person training.** **What You Will Do** To provide comprehensive utilization management and coordination of care for SRS Members. Ensure ... in a hospital or clinical setting. + 2 Years utilization /Case Management experience, preferably in a Managed... necessity are issued under the direction of the Medical Director or designee. + Data and… more
- CVS Health (Sacramento, CA)
- …nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists management with training new nurse ... Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and unrestricted RN… more
- Ventura County (Ventura, CA)
- …communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... Medical Director , Ventura County Health Care...procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval… more
- Sharp HealthCare (San Diego, CA)
- …for the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for ... professional leadership and direction to the functions within the Medical Management Department ( Utilization /Cost ...Program and Quality Improvement Program, in conjunction with the Director of PHM/ Medical Management … more