- Elevance Health (CA)
- …+ May process a medical necessity denial determination made by a Medical Director . + Develops and fosters ongoing relationships with physicians, healthcare ... initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes....a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... medical record and provides information to the department head as indicated. + Utilization review and utilization managementThe RN CM I will:Conduct… more
- CenterWell (San Diego, CA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Cedars-Sinai (Beverly Hills, CA)
- **Job Description** The Case Management Coordinator provides support to the utilization review process. The coordinator works collaboratively with all team ... eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/Manager/ Director / Medical Director to research any issues (ie… more
- Cedars-Sinai (Beverly Hills, CA)
- …You Will be Doing** The Case Management Coordinator provides support to the utilization review process. The coordinator works collaboratively with all team ... eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/Manager/ Director / Medical Director to research any issues (ie… more
- Veterans Affairs, Veterans Health Administration (Mather, CA)
- …receives program direction and guidance from the team's leadership, ie, charge nurse and medical director . Work Schedule: Monday - Friday 8:00 am to 4:30 pm, ... Summary The Medical Support Assistant (MSA) will perform administrative support...delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure… more
- LA Care Health Plan (Los Angeles, CA)
- …to the Supervisor of ECM and receives clinical supervision as needed from the Medical Director of Care Management. The position is responsible for providing ... and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required… more
- Dignity Health (Bakersfield, CA)
- …of defined levels of hierarchy and composition of compliant denial notices to review medical records, authorize requested services and prepare cases for ... physician review based on medical necessity. The position...needed to make a determination and/or coordinate with the Medical Director as needed. - Ensure compliance… more
- Dignity Health (Bakersfield, CA)
- …of defined levels of hierarchy and composition of compliant denial notices to review medical records, authorize requested services and prepare cases for ... physician review based on medical necessity. The position...needed to make a determination and/or coordinate with the Medical Director as needed. - Responsible to… more
- Fresenius Medical Center (San Bernardino, CA)
- …Manager to oversee the facility's Home Therapies Program. * Maintains integrity of medical and operations records and complies with all data collections and auditing ... activities. *Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. *Manages clinic financials including… more