- UCLA Health (Santa Monica, CA)
- …Nursing staff) + CA RN License and BLS certification + Recent experience in case management , utilization management and discharge planning + Minimum of three ... safe, high quality, efficient, and cost-effective care. You will also perform utilization review while assuring the delivery of concurrent and post-hospital care.… more
- Humana (Sacramento, CA)
- …health initiatives. + Collaborate with various operational functions in the centralized utilization management team and other shared services. + Participate in ... metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management , PCP visit rates and effectiveness, and member engagement strategies). +… more
- Elevance Health (Walnut Creek, CA)
- …preferred. + Extensive spine surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. + **Orthopedic ... Associate Medical Director** **Orthopedic Spine Surgery** **Carelon Medical Benefit Management ** **Schedule: 10:30 AM-7 PM Central** **Virtual:** This role enables… more
- CenterWell (Sacramento, CA)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent ... community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a related field +… more
- Evolent (Sacramento, CA)
- …billing and various sites of care/service + Familiarity with value-based care and utilization management + Understanding of data systems and the critical ... member-centric products. This role plays a critical part in both **Medical Cost Management ** and **Product Management ** , leveraging advanced analytics to solve… more
- Emanate Health (Covina, CA)
- …Two years recent acute clinical experience. Experience with discharge. Planning, utilization management and critical pathways preferred. Effective written, ... care and services of selected patient populations. Promotes effective utilization and monitoring of health care resources. Interacts with...verbal and time management skills. Ability to work independently as well as… more
- Veterans Affairs, Veterans Health Administration (Loma Linda, CA)
- …with consulting specialty services is required; Experience supervising physicians and supporting utilization management as a Physician Utilization ... Management Advisor (PUMA) is preferred; Must be able to receive faculty appointment at our affiliate university to oversee residents, interns and fellows. Reference: For more information on this qualification standard, please visit… more
- Evolent (Sacramento, CA)
- …critical role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a ... developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based models.** + Process… more
- Humana (Sacramento, CA)
- …during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy Adoption (MCPA) + ... **Desired Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Commercial and/or Medicare) + Proven… more
- Elevance Health (CA)
- …Washington Medicaid operations by providing clinical leadership and oversight across utilization management , appeals, and program innovation. This position ... and/or independently performs clinical reviews. + Typically has program management responsibilities including clinical policy development, improvement of quality,… more