- 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
- University of Southern California (Alhambra, CA)
- …Care Management Coordinators. 4. Makes appropriate referrals to supervisor or Medical Director , communicating accurate clinical information. 5. Participates in ... 1. Demonstrates sound clinical knowledge base regarding CM standards, UM standards, clinical standards of care, NCQA requirements, CMS...(MCG and/or InterQual) competency testing as requested by department director or Medical Director . +… more
- Evolent (Sacramento, CA)
- …participate in meetings as assigned with practices and/or payers. Will work with the Director of UM to ensure client satisfaction. Perform all peer clinical ... under the auspices of the office of the Chief Medical Officer. **ESSENTIAL DUTIES AND RESPONSIBILITIES** : include the...with one of the cardiologists. Responsible for coordinating with UM staff to ensure timely and accurate communication of… more
- Datavant (Sacramento, CA)
- …appropriate letter language to author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted ... + Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely...table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred + Knowledge of CMS, State Regulations,… more
- Cedars-Sinai (Beverly Hills, CA)
- …Express) no later than date of discharge. + Communicates regularly with CSMPN Medical Director , Employee Health Services, Risk Management, and TPA + Attends ... 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded...with 2 or more year of care management experience ( UM or DC Planning). + 1 year of previous… more