- 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
- Highmark Health (Sacramento, CA)
- …DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the multidisciplinary team ... :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities...care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy… more
- Sharp HealthCare (San Diego, CA)
- …in-patient Care Management program that includes initial and concurrent review ; case management/discharge planning activities. Responsible for operational planning ... consistent with existing policies and/or principles. Responsible for managing medical management activities to include tracking, trending and analyzing UM data.… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... medical record and provides information to the department head as indicated. + Utilization review and utilization managementThe RN CM I will:Conduct… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... to physician instruction. May schedule patient appointments.In partnership with physician , may review pre-printed teaching materials or written instructions… more
- Dignity Health (Rancho Cordova, CA)
- …years Utilization experience required in health plan/UM operations, Acute or subacute utilization review . - Graduate of an accredited school of nursing. - BS ... a referral. Fosters the relationship between the Pre-Authorization team and the Medical Director and Physician Reviewers. - Tracks cost savings from activities… more
- Humana (Sacramento, CA)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to… more
- Humana (Sacramento, CA)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to… more
- Sharp HealthCare (La Mesa, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... **Facility:** Medical Plaza **City** La Mesa **Department** **Job Status**...and routes to physicians. Returns phone calls according to physician instruction. May schedule patient appointments.In partnership with … more
- Travelers Insurance Company (Sacramento, CA)
- …other medical resources as appropriate. Train and evaluate physician and non- physician medical review personnel and activities. + Stay apprised of ... influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State… more