- Elevance Health (Walnut Creek, CA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military ... Capabilities and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience. For… more
- Bayer (Berkeley, CA)
- …High-Throughput (HT) Systems Expert role focuses on supporting and integrating utilization of digital and high throughput technologies within the Biologics DS ... VACC leadership behaviors; is an advocate for building digital mindset and HT utilization in the cluster in collaboration with other HT experts. + Demonstrates high… more
- CVS Health (Sacramento, CA)
- …AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... transferring patients to lower levels of care. + 1+ years' experience in Utilization Review. + CCM and/or other URAC recognized accreditation preferred. + 1+ years'… more
- TriMas Corporation (El Cajon, CA)
- …business processes and profitability. Key reporting includes: Direct labor efficiency and utilization - understand trends and profit impacts, work with operations to ... and streamline current accounting and reporting procedures. Drive further ERP utilization and optimization to streamline key business processes. Recommend and… more
- Evolent (Sacramento, CA)
- …**What You Will Be Doing:** + Responsible for oversight of utilization management (UM)/care management (CM) correspondence development, internal and external ... adeptly negotiate internally and externally around interpretation and application of utilization review law, accreditation standards and policy. + Ensures team… more
- Abbott (Los Angeles, CA)
- …loyalty, and value expansion revenue in assigned accounts. + Divides on parts utilization within the pre-approved budget range for the role. Parts utilization ... decisions outside of the pre-approved budget range require management approval. Accountable for on-hand trunk inventory accuracy. + Critical contribution to the effectiveness of the CAPA system with responsibility for accurate documentation of customer… more
- Amergis (Orange, CA)
- …help support a health insurance agency! The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for ... as those listed above may also be qualifying. Preferred Qualifications: + Utilization management reviewer experience. + Managed care experience. + Behavioral health… more
- Providence (Fortuna, CA)
- …staff, hospital personnel and outside resources to ensure the appropriate utilization of resources according to clinical and financial standards. Monitors the ... field. + CCM or ACM + 2 years case management, discharge planning, or utilization management experience in the acute, sub-acute, home health setting or managed care… more
- UCLA Health (Los Angeles, CA)
- …with discharge/post-hospital care + Interacting with hospital departments such as Utilization Review and Patient Business Services to ensure correct and timely ... + Knowledge in the functional operations of third party payers and utilization review agencies to expeditiously coordinate follow-up + Working knowledge of third… more
- UCLA Health (Los Angeles, CA)
- …delegated entities and ensure compliance * Manage claims processing and formulary utilization * Analyze drug utilization trends to identify cost-saving ... opportunities * Coordinate member communications * Collaborate closely with delegated medical groups * Lead initiatives to improve medication adherence and STAR ratings * Ensure timely and accurate Medicare reporting * Support the development of Medicare Part… more