- 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
- CenterWell (San Diego, CA)
- …care plans and interpreting patient needs, while adhering to Company, physician , and/or health facility procedures/policies. + Manages the assignment of caregivers. ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- Highmark Health (Sacramento, CA)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... nature for profiling providers, assessing patient outcomes, studying cost and utilization trends and quantitative projections of industry and competitor performance,… more
- Humana (Sacramento, CA)
- …The Medical Director may occasionally speak with contracted external physicians, physician groups, facilities, or community groups to support regional market ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or… more
- Elevance Health (Walnut Creek, CA)
- **Genetic Counselor Review Associate** **Genetic Testing Utilization Review** **Carelon Medical Benefits Management** **Virtual** : This role enables associates to ... whether clinical information presented meets medical necessity criteria or requires physician review or override. + Clearly and concisely documenting clinical review… more
- Cedars-Sinai (Los Angeles, CA)
- …organizing and managing of assigned areas. Works closely with leadership and physician management in the centralized infrastructure development and operations for a ... + Manages the administrative and clinical services for one or more physician office sites. + Plans, coordinates, implements and monitors projects and initiatives… more
- Sharp HealthCare (La Mesa, CA)
- …inventories as required per policy and procedures.-Demonstrates proficiency with and utilization of automation and advances in technology (EMR System, Automated ... Dispensing Cabinet system (Pyxis), IV Workflow Management system (DoseEdge), physician order entry, etc.)-Demonstrates knowledge of age specific medication delivery… more
- Evolent (Sacramento, CA)
- …is a key clinical executive responsible for leading oncology-related utilization management, quality improvement, and clinical operations across Evolent's ... oncology care + Lead the development of strategies for care management, utilization mitigation, and value-based incentive programs **Desired Skill Set** + 15+ years… more
- Sharp HealthCare (La Mesa, CA)
- …+ 1 Year experience as a Certified Radiation Therapist in a physician 's office or hospital setting. **Other Qualification Requirements** + Satisfactory completion of ... Meeting attendanceDemonstrates an orderly and logical approach to resource utilization .Consistently utilizes time management skills to improve efficiency/ effectiveness… more
- The County of Los Angeles (Los Angeles, CA)
- …nursing, and administration. Incumbents seek the expert opinion or advice of a physician whenever the incumbent determines if a case falls outside the scope ... by policies and protocol. The Nurse Practitioner plans and implements and a physician reviews and confirms health care goals for patients. The Nurse Practitioner… more