- Evolent (Sacramento, CA)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- AECOM (San Francisco, CA)
- …in order to be able to identify support personnel and facilitate the quality review process for any regional project. In the event quality issues are identified, ... major pursuits by actively participating in the development and review of Project Plans and incorporation of other project...set up tools. + Support operations by balancing architecture utilization and staffing across the region as well as… more
- Genesis Healthcare (Carmichael, CA)
- …Powerback is the place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time team members. We offer Dental and ... Clinical Operations Area Director in the timely completion of the annual merit review for therapy staff. 7. Assists Clinical Operations Area Director in the hiring… more
- Sharp HealthCare (San Diego, CA)
- …when not in use.Is knowledgeable of current laws and regulations regarding Utilization Review and Discharge Planning.Morning arrival time insures orderly ... + Data collectionParticipates in data and statistics collection as requested by Utilization Review , Service Line and Quality Improvement Committees. + Denial… more
- Elevance Health (Los Angeles, CA)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… more
- Dignity Health (Bakersfield, CA)
- …to senior leadership. - Analyzes network performance, including cost, quality, and utilization data to identify trends, opportunities, and areas for improvement. - ... health plan negotiations. - Coordinate the implementation of contracts including review of fee sets, division of financial responsibilities, and provider… more
- Fujifilm (Sacramento, CA)
- …courses, and grant requests received by Fujifilm from industry societies, Academic Medical Centers, and other health-related organizations in the West and South ... received by the Fujifilm Endoscopy Division from industry societies, Academic Medical Centers, and other health-related organizations in the West and South-Central… more
- Providence (Napa, CA)
- **Description** Social Worker MSW in Utilization Review Unit at Queen of the Valley Medical Center, CA. This position is Full time and will work 8-hour Day ... Shifts. **Providence Queen of the Valley Medical Center** Providence Queen of the Valley ...**Job Shift:** Day **Career Track:** Clinical Professional **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas… more
- Sharp HealthCare (La Mesa, CA)
- …required within 90 days of hire. **Essential Functions** + Verification and review of medication ordersReviews all medication orders for appropriate dose, duration, ... protocols and consultation with the interdisciplinary team.-Completion of a daily profile review for each patient consisting of the following elements:* Age, sex,… more
- Sutter Health (San Francisco, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more