- Cedars-Sinai (Marina Del Rey, CA)
- …the established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review ... for identified contracted/private patients collaborates with on-site and/or outside reviewers. + Keeps patients informed of progress and provides information related to disease progression. + Collaborates with discharge planner to make orders and arranges for… more
- Highmark Health (Sacramento, CA)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
- Sharecare (Sacramento, CA)
- …and objectives of the Disease Management program by providing high quality telephonic and omni - channel support in an appropriate, efficient and cost-effective ... nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… 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
- CVS Health (Sacramento, CA)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- CVS Health (Eureka, CA)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... appropriate under the direct supervision of a licensed pharmacist + Taking telephonic prescriptions from the prescriber, and calling the prescriber to clarify… more