- Sharp HealthCare (San Diego, CA)
- … medical management activities to include tracking, trending and analyzing UM data. Works in collaboration with regional medical directors, ambulatory ... and hospital case management departments. Participates in the development of the annual UM plan and implementation of corrective action plans related to health plan… more
- LA Care Health Plan (Los Angeles, CA)
- …the needs of LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists UM Educator/Manager/ Director ... that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations...Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical , Dental and Vision + Wellness Program + Volunteer… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM /Prior Authorization. Skills Required: Demonstrated proficiency in Medical Terminology ... Job Summary The Authorization Technician II supports the Utilization Management ( UM ) Specialist by handling all administrative and technical functions of the… more
- Actalent (Sacramento, CA)
- …case reviews + Escalate complex or ambiguous cases to the Vivant Health Medical Director or Physician Reviewer + Ensure complete, accurate, and compliant ... + Apply CMS regulations and evidence-based criteria (MCG, InterQual) to evaluate medical necessity + Collaborate with hospital teams, providers, IPA case managers,… more
- Dignity Health (Rancho Cordova, CA)
- …criteria. This position will work closely with the hospitalist team, Dignity Health Medical Foundation Medical Director 's, specialists, clinic staff and ... and policies. Approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other. - Complete medical … more
- Sharp HealthCare (San Diego, CA)
- …business practices. **What You Will Do** Under the direction of the Sharp Community Medical Group (SCMG) Director for Health Service and in collaboration with ... legislative compliance for the division. Under the direction of the SCMG Director for Health Services, develops financial (budget) and operational strategy of HCM… more
- LA Care Health Plan (Los Angeles, CA)
- …to the Supervisor of ECM and receives clinical supervision as needed from the Medical Director of Care Management. The position is responsible for providing ... internal LA Care departments such as Care Management (CM), Utilization Management ( UM ), Managed Long Term Services and Support (MLTSS), Social Services, Behavioral… more