- Highmark Health (Sacramento, CA)
- …Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, ... guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and files,… more
- Providence (Apple Valley, CA)
- …field (Acute, Ambulatory, Post-Acute, etc.). + 2 years of experience in Case Management (Care Coordination or Utilization Management ) or successful ... available are Per Diem and will work 8-hour Variable Shifts.** Case Management is a collaborative practice including patients, caregivers, nurses, social workers,… more
- Magellan Health Services (San Diego, CA)
- …manage and oversee activities of assigned care support teams. Experience with Care Management flows. Knowledge of utilization management procedures, mental ... appropriate and effective person-centered care plan, member education and care management . Conducts initial and concurrent review for prior authorization of higher… more
- UCLA Health (Los Angeles, CA)
- …Licensure) Experience, Skills and Abilities: * Five years of hospital utilization management experience, with demonstrated success in quality improvement ... management , care variation management , patient flow/throughput management , ancillary services utilization and clinical documentation improvement. The… more
- Highmark Health (Sacramento, CA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Humana (Sacramento, CA)
- …licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home ... review depending on case findings. + Educates providers on utilization and medical management processes. + Enters and maintains pertinent clinical information in… more
- Dignity Health (Bakersfield, CA)
- …necessary areas that collaborate with the contracting department (ie, Claims, Utilization Management /Authorizations, Benefits, and Finance) to provide contract ... to senior leadership. - Analyzes network performance, including cost, quality, and utilization data to identify trends, opportunities, and areas for improvement. -… more
- Regeneron Pharmaceuticals (Los Angeles, CA)
- …highly challenging for HCPs and Patients. Payer Formularies and restrictive Utilization Management Criteria including: Prior Authorization Processes, Step Edits, ... knowledge on the local and national payer landscape, including Specialty Pharmacy and Utilization Management criteria for assigned products This role may be a… more
- Intuit (Mountain View, CA)
- …education programs that drive speed to benefit through feature adoption and utilization , proactive health management , and retention programs + Define and ... end-to-end service delivery design including feature adoption, proactive health management , support excellence, and customer insight programs for customers… more
- Providence (Tarzana, CA)
- … management of the patient along the continuum of care, utilization activities, disease management appropriateness, discharge planning, patient education ... **Description** RN Manager of our Care Management team at Providence Cedars-Sinai Tarzana Medical Center...Providence Cedars-Sinai Tarzana Medical Center in Tarzana, CA. This management position is Full-Time and will work Day shifts.… more