- Sharp HealthCare (San Diego, CA)
- …physicians (Medical Directors (both medical and behavioral health) and the Physician Reviewers) to coordinate the necessary co-management of our members related ... medical, behavioral health and pharmacy needs. This position also provides the physician cohesive collaboration necessary for the continuum of care foundation for… more
- Ventura County (Ventura, CA)
- …other community providers. VCHCP also provided insurance coverage for employees of physician groups through the end of December 2022. Medical Director, Ventura ... medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as a… more
- Centene Corporation (Sacramento, CA)
- …of Certifying Board Service (Internal and Family Medicine, preferred) + Utilization Management experience and knowledge of quality accreditation standards. + ... for the business unit. + Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs… more
- Sharp HealthCare (San Diego, CA)
- …a comprehensive plan of care for each patient/family in collaboration with the physician , social worker and all members of the interdisciplinary team in the ... position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving care… more
- Dignity Health (Rancho Cordova, CA)
- …guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of services for ... of referral reviews correct selection of criteria accurate prep to the UM Physician reviewer when indicated timely verbal and written documentation and completion of… more
- Providence (Irvine, CA)
- **Description** Utilization Management RN - Clinical Program Manager (Remote) at Providence Holy Cross Medical Center in Mission Hills, CA. This position is ... and ministry teams. Fosters collaborative working relationships within and beyond the Utilization Management and Care Coordination teams, acting as a resource and… more
- Evolent (Sacramento, CA)
- …requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business ... and management staff as well as health plan members and staff whenever a physician `s input is needed or required. Responsible for clinical audits for quality and… more
- Alameda Health System (Oakland, CA)
- …AHS Utilization Review Committee. + Responsible for overseeing patient, physician and staff satisfaction based on quality outcomes and patient experience ... the collection, analysis and presentation data relevant to the utilization of healthcare resources, including but not limited to...Works closely with the VP of Care Management and Physician Advisors on any audits and secondary reviews; may… more
- Sharp HealthCare (San Diego, CA)
- …policies and procedures including authorizations and referrals, claims/encounters, provider utilization reports and grievance procedures; b) Rules, regulations, and ... standards established by regulatory and accreditation agencies; and c) Training in the utilization of the SHP provider portal as a tool to enhance the provider's… more
- Hospice Of San Joaquin (Stockton, CA)
- …the time of the patient's death with coordination of services with the physician , mortuary, DME, and supplier. + Assists family in making transition from caregiving ... advocate, in collaboration with Case Manager, IDT, and primary physician . + Additional duties as assigned. INTERDISCIPLINARY COLLABORATION/COMMUNICATION: Ensure… more