• UM LVN

    Dignity Health (Bakersfield, CA)
    …Gathering all information needed to make a determination and/or coordinate with the Medical Director as needed. - Responsible to coordinate with contracting to ... decision-making. - Ensures that there is evidence that the UM nurse reviewer documented communications with the requesting provider...for accessibility within the network. - Consults with the medical director on cases that do not… more
    Dignity Health (07/13/25)
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  • Coordinator, UM Intake

    Evolent (Sacramento, CA)
    …operations this individual also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: ... Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. **What You Will Be Doing:** + Reviewing… more
    Evolent (09/06/25)
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  • Case Management Coordinator - Inpatient Specialty…

    Cedars-Sinai (Beverly Hills, CA)
    …member eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/Manager/ Director / Medical Director to research any ... when requested. + Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors or Management. + Processes… more
    Cedars-Sinai (08/08/25)
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  • Case Management Coordinator (Hybrid) - MNS…

    Cedars-Sinai (Beverly Hills, CA)
    …member eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/Manager/ Director / Medical Director to research any ... when requested. + Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors, or Management. + Processes… more
    Cedars-Sinai (07/18/25)
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  • Senior Medical Director - Sharp…

    Sharp HealthCare (San Diego, CA)
    …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons...+ Achieves and maintains benchmarked utilization and cost management ( UM ) goals and clinical quality improvement (QI) objectives, in… more
    Sharp HealthCare (07/19/25)
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  • Director , Utilization Management

    Alameda Health System (Oakland, CA)
    Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
    Alameda Health System (08/08/25)
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  • Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …as a physician executive in a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical ... **Shift Start Time** **Shift End Time** California Physicians and Surgeons License - Medical Board of CA; Doctor of Medicine (MD) **Hours** **:** **Shift Start… more
    Sharp HealthCare (08/17/25)
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  • Medical Director - Commercial

    CVS Health (Sacramento, CA)
    … UM experience with a Health plan/payor experience. *Electronic medical systems/record experience *Managed Care experience *Board certification in Internal ... in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management...clinical / medical programs and expand Aetna's medical management programs to address member needs across the… more
    CVS Health (08/21/25)
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  • Director Provider Contracting

    Dignity Health (Bakersfield, CA)
    **Responsibilities** This position is remote.** **Position Summary:** The Director of Provider Contracting is a key executive leader responsible for the strategic ... the full contract lifecycle for physicians, facilities, and ancillary providers. The Director plays a pivotal role in maximizing clinical, financial, and experience… more
    Dignity Health (07/24/25)
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  • Director of Clinical Services, Faculty…

    UCLA Health (Los Angeles, CA)
    Description We are seeking a highly skilled and dynamic Director of Clinical Services to lead the development, evaluation, and implementation of multiple clinical ... programs and medical services with an emphasis on optimizing Utilization Management...will: + Oversee the development and execution of multiple UM processes and workflows, while continuously identifying and evaluating… more
    UCLA Health (06/22/25)
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