- 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
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- Ventura County (Ventura, CA)
- …Under direction, scheduled as needed to assist with patient care coordination and utilization review . The incumbent will be responsible to assist with evaluation ... of: + The theory, techniques, and practices of professional nursing within utilization management; + medical terminology and hospital routine and equipment;… more
- LA Care Health Plan (Los Angeles, CA)
- …referrals (5%) Performs prospective, concurrent, post-service, and retrospective claim medical review processes. Utilizes clinical judgement, independent ... admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests where determination requires… more
- CVS Health (Sacramento, CA)
- …in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure… more
- Actalent (Redlands, CA)
- …with internal staff to ensure seamless care coordination. Essential Skills + Utilization review and management experience. + Familiarity with Medicare, ... Job Title: Remote LVN Case Manager - Utilization Management Job Description Join our dynamic ...+ Experience working with provider offices. + Familiarity with MediCal and Medicare regulations. + Proficiency in EZ-CAP is… more
- Elevance Health (Walnut Creek, CA)
- ** Utilization Management Representative I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person ... Friday, an 8-hour shift between 8 am - 8 pm EST. The ** Utilization Management Representative I** is responsible for coordinating cases for precertification and prior… more
- CenterWell (Sacramento, CA)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CenterWell (Sacramento, CA)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more