- Humana (Sacramento, CA)
- …a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ ... vulnerable members. The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training… more
- Sutter Health (Sacramento, CA)
- …expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices, level ... Health Internal Physician Advisor Services (IPAS). The physician Advisor will work closely with the medical... physician Advisor will work closely with the medical staff, including house staff, and all utilization… more
- The County of Los Angeles (Los Angeles, CA)
- …staff training is needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to ... Medi-Cal reimbursement. + Analyzes cases for referral to the physician advisor to ensure that the admission or continued...I:One year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator,… more
- The County of Los Angeles (Los Angeles, CA)
- … direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one ... hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty...utilization review standard. Under the direction of a physician member of the Utilization Review Committee,… more
- Alameda Health System (Oakland, CA)
- … utilization . This role supports patient care coordination, fosters physician collaboration, and aligns with organizational objectives while adapting to ad ... Director, Utilization Management + Oakland, CA + Highland General...utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures. + Analyze data… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in ... System Utilization Management SUM Utilization Review RN...high- standards of patient care. This role involves evaluating medical necessity, assessing treatment plans, and collaborating with healthcare… 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 ... Utilization Management Admissions Liaison RN II Job Category:...to issue a determination based on clinical criteria for medical necessity. Assures timely, accurate determination and notification of… more
- HCA Healthcare (Riverside, CA)
- …will serve as a consultant to hospital Medical Staff Services regarding physician credentialing, utilization , and quality profiling. Serves as a member of ... program development, and overall hospital strategy + You will provide medical director services to facility-level physician credentialing, business development,… more
- Dignity Health (Carmichael, CA)
- …Physician Advisor - Champion Quality Care at Dignity Health Mercy San Juan Medical Center** Are you a physician leader passionate about optimizing patient ... care and resource utilization ? Dignity Health Mercy San Juan Medical ...practice, regulatory and quality considerations in the delivery of medical care. The Physician Advisor plays a… more
- Dignity Health (Carmichael, CA)
- …Are you a physician leader passionate about optimizing patient care and resource utilization ? Dignity Health Mercy San Juan Medical Center, a leading Level 2 ... Staff, Nursing Staff, and Administration. You will champion evidence-based standards of medical care, ensure appropriate utilization of hospital resources, and… more