- Highmark Health (Sacramento, CA)
- …The Senior Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal ... insights and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes… more
- Actalent (Sacramento, CA)
- Utilization Review Nurse (LVN) - InpatientPrimary Responsibilities + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, ... CMS regulations and evidence-based criteria (MCG, InterQual) to evaluate medical necessity. + Collaborate with hospital teams, providers, IPA...ICU). + At least 1 year of experience in utilization review , case management, or hospital discharge… more
- LA Care Health Plan (Los Angeles, CA)
- Authorization Technician II (12 Month Assignment) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... that purpose. Job Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions… more
- LA Care Health Plan (Los Angeles, CA)
- …policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position ... can include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to… more
- Evolent (Sacramento, CA)
- …team approach with call center staff. Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + ... Nurse, you will be a key member of the utilization management team. We can offer you a meaningful...other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors. **What You Will Be Doing:** + Functions… more
- Evolent (Sacramento, CA)
- …team approach with call center staff. Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + ... Nurse, you will be a key member of the utilization management team. We can offer you a meaningful...other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors. **What You Will Be Doing:** + Functions… more
- Dignity Health (Redwood City, CA)
- …to their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Qualifications** **Minimum Qualifications** **Required ... will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute… more
- LA Care Health Plan (Los Angeles, CA)
- …with internal departments (Member Services, Provider Network Operations, Claims, Utilization Management, Pharmacy, and Quality Management) to ensure the use ... member correspondence for accuracy, clarity, and cultural appropriateness and sensitivity. Review grievance and State Fair Hearing files for compliance with Policies… more
- Jacobs (Los Angeles, CA)
- …other methodologies including, but not limited to, Asset Condition Assessment, Criticality Review and Risk Based Optimization. In this role, you'll ultimately ensure ... initiative, aimed to keep the preventive maintenance program up to date * Review and recommend new technologies aimed at improving equipment life cycle * Defines… more
- Sutter Health (Roseville, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of ... acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the… more