- Dignity Health (Arnold, CA)
- …services provided; participate in annual review of patient health records and utilization review studies of the Clinic services + Maintain confidentiality of ... performing diagnostic and therapeutic procedures, and prescribing and minister medical treatments and medication; collaborate/supervise with the nurse practitioner/physician… more
- LA Care Health Plan (Los Angeles, CA)
- …through Plunet and Language Vault and all tasks associated including invoice review . Maintain translation memory, glossary and style guides for optimal translation ... outcomes and review periodically. Monitor and manage vendors' performance through observation,...as needed. Prepare translation/alternative format sections of reports (eg utilization reports and annual evaluation), including but are not… more
- CVS Health (Sacramento, CA)
- …day. **Position Summary:** This Case Manager RN position is with Aetna's National Medical Excellence (NME) team and is a fully remote position. Candidates from any ... is a blended role doing both Case Management and Utilization Management. The RN Case Manager is responsible for...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Cardinal Health (Sacramento, CA)
- …the Nephrology field specifically, working with dialysis providers distributing pharmaceutical medical supplies from wholesale. You will meet with buyers detailing ... our service and pricing terms to service pharmaceutical medical supply to their facility. This role will also...seize the identified opportunity, execute strategy. Resulting in additional utilization of the Cardinal Service offering. + Prepare and… more
- Magellan Health Services (San Diego, CA)
- …care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical ... needs assessment including, but not limited to, psycho-social, physical, medical , behavioral, environmental, and financial parameters. + Develops, documents,… more
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... the patients in his/her caseload in the following areas; admission criteria for medical necessity and appropriateness of care; continued stay criteria for medical… more
- Pfizer (Sacramento, CA)
- …and applying insights in local planning * Act decisively by prioritizing resource utilization to meet customer needs * Provide key HQ colleagues, including Brand ... actionable, and solutions focused feedback * Ensure effective and compliant utilization of promotional materials. * Ensure successful, compliant selling activities… more
- Humana (Sacramento, CA)
- …and help us put health first** The Regional VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Regional VP, ... & Market Performance: + Serve as the clinical steward for regional medical expense trends, leveraging data to guide interventions, and ensure fiscal accountability.… more
- CommonSpirit Health (Rancho Cordova, CA)
- …not limited to: hospital administration, nursing leadership or their designee, medical staff, physicians and transportation vendors to ensure patients are assigned ... performed and communicating with department manager and director the outcomes of the review and any identified issues or barriers. **Core Duties:** + Compiles data… more
- Gilead Sciences, Inc. (Santa Monica, CA)
- …even bigger advances in cancer therapies, and help shape where our business and medical science goes next. We believe every employee deserves a great leader. People ... analyzing resource data provided to Kite leadership and project teams + Review demand forecasts with cross-functional teams and project managers to gather accurate… more