- CVS Health (Sacramento, CA)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.** -OR- OPTION II:… 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 ... System Utilization Management SUM Utilization Review...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print...over the nursing staff engaged in utilization review activities at Los Angeles General Medical ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 - $177,314.88 Annually… more
- Prime Healthcare (Ontario, CA)
- …is actively seeking new members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization ... review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry,… more
- Prime Healthcare (Ontario, CA)
- …is actively seeking new members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization ... health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working… more
- Sutter Health (Sacramento, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices,… more
- Emanate Health (Covina, CA)
- …the United States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical … more
- Centene Corporation (Sacramento, CA)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Centene Corporation (Sacramento, CA)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
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