- United Therapeutics (CA)
- …awareness during the entire access process which may include formulary coverage/ utilization management criteria, insurance forms & procedures, benefits ... investigation, prior authorization, appeal, and/or claims resolution + Educate physician office staff on the use of patient support services using UT approved educational materials, including web-based provider portals and other tools/resources as available… more
- Sutter Health (Santa Cruz, CA)
- …of care within an interdisciplinary team and participating in effective utilization management and control of patient supplies. Consistently provides ... manner. + Excellent collaborative and problem solving skills with customers and management . + Ability to exercise independent sound judgment in planning and… more
- Sutter Health (Alameda, CA)
- …of care within an interdisciplinary team and participating in effective utilization management and control of patient supplies. Consistently provides ... manner. + Excellent collaborative and problem solving skills with customers and management . + Ability to exercise independent sound judgment in planning and… more
- Dignity Health (Bakersfield, CA)
- …emphasis will be on care coordination communication and collaboration with utilization management nursing physicians ancillary departments insurers and post ... two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. + California RN license +… more
- Evolent (Sacramento, CA)
- …various sites of care/service is preferred + Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the ... will partner closely with executives across analytics, finance, product and account management . **What You Will Be Doing:** + Support Business Development & Product… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …manages clinical staff schedules, maintains compliance with routine audits of staff, utilization management , performance improvement, and other duties, as deemed ... role. Administrative duties include staff or program development, development and management of team goals, quality assurance and adherence to clinical treatment… more
- Prime Healthcare (Ontario, CA)
- …of the department. + Enable efficient operations by monitoring enrollment, utilization , case management , member services, claim processing, provider and ... Departments and forwards the organizational goals and objectives of senior management . Analysis of financial, operational performance and reporting completed to… more
- Humana (Sacramento, CA)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health insurance ... organizations, hospitals and other healthcare providers, patient interaction, etc. + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, PM&R, Anesthesiology and General Surgery clinical specialists **Work at Home Guidance** To… more
- Humana (Sacramento, CA)
- …economics, and/or other specific healthcare areas such as EMR, Episode grouper, utilization management , value-based care, low value care etc. **Additional ... Information** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload… more
- Monte Nido (Agoura Hills, CA)
- …and outpatient providers + Interact with insurance companies for pre-certification and utilization management + Participating in discharge and aftercare planning ... + Therapeutic meal support, while modeling a healthy relationship with food + Provides safe, empathetic, and affirming care for each client and their unique circumstance based on the clients' intersecting identities Qualifications: + Master's degree in… more