- Prime Healthcare (Chino, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/219949/case-manager-%28rn%29 utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityChino Valley … more
- Prime Healthcare (Anaheim, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/218947/case-manager utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityWest Anaheim … more
- Prime Healthcare (San Dimas, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, ... is not limited to: + Paid time off + 401K retirement plan + Outstanding Medical + Dental + Vision coverage + Tuition reimbursement + Many more voluntary benefit… more
- Providence (Santa Rosa, CA)
- …minimize the risk by collaborating with management, medical staff and medical center personnel. Provides payor/ utilization review organizations with ... patients throughout their admission to ensure the availability of sufficient clinical and medical center resources. Communicates on a daily basis with medical … more
- Ventura County (Ventura, CA)
- …awarded by CDPH. + Develops and presents therapeutic class review for medical staff review to include utilization , financial analysis, contract ... medical and pharmacy literature; communicate clearly and effectively; review and verify medication orders accurately and timely through electronic health… more
- Prime Healthcare (Garden Grove, CA)
- …coding staff, physicians, financial services, onsite and remote utilization review teams with regards to admission criteria, medical necessity, payment ... communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Works with health information… more
- Elevance Health (Costa Mesa, CA)
- … Director** **Carelon Medical Benefits Management** **Radiology Benefit** **Management/ Utilization ** ** Review ** **Virtual:** This role enables associates to ... decisions. + Brings to their supervisors attention, any case review decisions that require + Medical Director...any case review decisions that require + Medical Director review or policy interpretation. **Minimum… more
- Centene Corporation (Sacramento, CA)
- …on member medical records in health management systems according to utilization management policies and guidelines + Works with healthcare providers to approve ... 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)
- …with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against guidelines and ... of care issues, and if identified, refer to the Medical Director or provider for review and...guidelines + Assists with providing education to providers on utilization processes to promote high quality, cost-effective, and efficient… more
- Ventura County (Ventura, CA)
- …+ Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + At ... care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review ...Review systems and programs + Direct patient care medical practice experience + Administrative experience + National Committee… more