- Highmark Health (Sacramento, CA)
- …and testing processes in partnership with the pharmacy benefits manager . The successful candidate will possess excellent communication, analytical, and ... RESPONSIBILITIES** + Monitor FDA-approvals, drug manufacturer pipelines, assess drug utilization reports, and write drug monographs for Committee review to… more
- Fresenius Medical Center (Los Angeles, CA)
- …pre, during and post procedure, under the direction of the Facility Manager , Director of Nursing and/or Charge Registered Nurse, utilizing standard nursing ... techniques to assist the physician in optimum patient outcomes following facility policies and...the facility and reports any issues to the Facility Manager . + Ensures a clean, safe and sanitary environment… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), … more
- Sharp HealthCare (San Diego, CA)
- …appropriate service delivery.Participates in clinical projects as directed by the physician or manager .Department specific requirements: + Department efficiency ... problem and routes to physicians. Returns phone calls according to physician instruction. May schedule patient appointments.In partnership with physician ,… more
- Sharp HealthCare (San Diego, CA)
- …appropriate service delivery.Participates in clinical projects as directed by the physician or manager .Department specific requirements: + Department efficiency ... problem and routes to physicians. Returns phone calls according to physician instruction. May schedule patient appointments.In partnership with physician ,… more
- Cedars-Sinai (Los Angeles, CA)
- …the Foundation, including patient assignment, risk and specialty network structures, and utilization management. Functions as a key resource for staff and physicians ... in support of these requirements. + In collaboration with the Operation Manager , develops business and operations plans for assigned areas, programs, and services.… more
- Sharp HealthCare (San Diego, CA)
- …May schedule patient appointments.Participates in clinical projects as directed by the physician or manager . + Human Resource ManagementProvides staff training, ... all phones in area). + Department Efficiency and EffectivenessMonitors patient flow, physician schedules and completes daily tasks to ensure quality and meet service… more
- Elevance Health (Walnut Creek, CA)
- …Determines the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + Conducts ... peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care… 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 ... the CEO, CFO, President of SCCIPA, AVP Claims and Manager of Network Operations. We want you to apply!...of Agreement as directed + Accountable for submitting monthly physician rosters to health plans based on Credentialing Committee… 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