- Molina Healthcare (Los Angeles, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_3-12 DAY SHIFT 7:30AM - 08:30PM...requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and… more
- Sharp HealthCare (San Diego, CA)
- …+ Provides professional leadership and direction to the functions within the Medical Management + Department ( Utilization /Cost Management and Quality Management) ... selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations. + Participates in the retrospective… more
- Sharp HealthCare (San Diego, CA)
- …+ Provides professional leadership and direction to the functions within the Medical Management Department ( Utilization /Cost Management and Quality Management) + ... selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations for updating current polices to meet… more
- Sedgwick (Sacramento, CA)
- …related line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. ... Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and...+ Strong team and customer service orientation + Three Medical , and two dental plans to choose from. +… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical ...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more
- HCA Healthcare (Riverside, CA)
- …a data-driven environment of quality and cost improvement, and develops systems to review utilization of resources and objectively measure outcomes of care in ... support for appeals and denials process, discharge planning, case management, and utilization review /management + You will consult with facility-level staff… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... + Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Sutter Health (Emeryville, CA)
- …practices. + Proficiency in utilization management processes: authorizations, concurrent review , and medical necessity criteria. + Thorough understanding of ... clinical oversight and direction for critical health plan functions-including utilization management, credentialing, authorizations, concurrent review , and… more
- Lompoc Valley Medical Center (Lompoc, CA)
- …degree preferred. + Experience: A minimum of two years of clinical experience in Utilization Review or Case Management is preferred. + Per Diem Positions: Case ... and hospital information systems required. Must demonstrate knowledge of current utilization management principles, third party payor review requirements,… more