- Alameda Health System (San Leandro, CA)
- …disposition of Medi-Cal, self-pay, and out-of-plan patients, including working with physician to determine readiness for transfer, securing placement and completing ... resource Management issues; other issues including concerns involving under/over utilization , avoidable days and quality issues. Coordinate daily with… more
- Sharp HealthCare (San Diego, CA)
- …all phones in area). + Department Efficiency and EffectivenessMonitors patient flow, physician schedules and completes daily tasks to ensure quality and meet service ... problem and routes to physicians. Returns phone calls according to physician instruction. May schedule patient appointments.Participates in clinical projects as… more
- The County of Los Angeles (Los Angeles, CA)
- …such finding are consistent with overall clinical symptoms indicated by the attending physician . When findings do not appear to be consistent with the clinical ... symptoms indicated by physician , Public Health Microbiologists...to include limitations of testing, reference methods, appropriate test utilization , and test interpretation. + Experience using diagnostic testing… more
- Sharp HealthCare (San Diego, CA)
- …patient's problem and routes to physicians.Returns phone calls according to physician instruction. May schedule patient appointments.In partnership with physician ... appropriate service delivery.Participates in clinical projects as directed by the physician or manager.Partners with physicians to continuously learn and expand… more
- HCA Healthcare (Campbell, CA)
- …to ensure functions such as Claims System Configuration, Customer Service, Utilization Management and Compliance are executing their assigned accountabilities. This ... CFO Letters of Agreement as directed + Accountable for submitting monthly physician rosters to health plans based on Credentialing Committee approvals + Accountable… more
- Actalent (Sacramento, CA)
- Utilization Review Nurse (LVN) - InpatientPrimary Responsibilities + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and ... + Escalate complex or ambiguous cases to the Medical Director or Physician Reviewer. + Ensure complete, accurate, and compliant documentation aligned with CMS… more
- Sedgwick (Sacramento, CA)
- …use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, trends, and ... data collection. + Interacts and coordinates work of physician advisors as needed; performs complex review of cases to identify referral for case management as… more
- Providence (Santa Rosa, CA)
- …staff, medical center personnel and outside resources to ensure the appropriate utilization of resources according to clinical and financial standards. Monitors the ... with management, medical staff and medical center personnel. Provides payor/ utilization review organizations with concurrent retrospective utilization review… more
- Humana (Sacramento, CA)
- …scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post… more
- Elevance Health (Walnut Creek, CA)
- …outside of the client health plan network. + Notifies ordering physician or rendering service provider office of the preauthorization determination decision. ... ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or… more