- 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
- Insight Global (Santa Barbara, CA)
- …Working with cross functional partners such as behavioral health, contact center, Utilization Management , Health Services vii. Data warehousing 1) Existing ... reports today 2) Gathering requirements 3) Explaining typical measures x. Yrs of experience - 6+ null We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an… 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. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office… more
- Mindoula Health (CA)
- …for outcome based care. + Participates in interdisciplinary team meetings and utilization management rounds and provides information to assist with safe ... transitions of care. + Promotes responsible and ethical stewardship of company resources. + Maintains excellent punctuality and attendance during work hours. Qualifications: + LCSW, LMFT, LMHC, in Washington State. + Preferred experience with substance abuse… more
- Norstella (Sacramento, CA)
- …or Specialty pharmacy. + Comprehensive knowledge of both pharmacy and medical benefit utilization management policies + Proven ability to exceed expectations and ... achieve goals + Excellent presentation and communication skills + Strong analytical and critical thinking skills + Strong organization skills with the ability to prioritize in a dynamic environment + Self-motivated with a strong "can do" attitude **Additional… more
- HCA Healthcare (Campbell, CA)
- …to ensure functions such as Claims System Configuration, Customer Service, Utilization Management and Compliance are executing their assigned accountabilities. ... This role is also accountable for co-leading the weekly Contracting Team meeting by preparing the agenda and open items for discussion and decision. The members of the Contracting Team include the CEO, CFO, President of SCCIPA, AVP Claims and Manager of… more
- Sharp HealthCare (Santee, CA)
- …all notes and billing daily.Completes all tasks and documentation needs (ie utilization management , plan of care, medical necessity reviews) based on ... department and regulatory requirements.*Professional and Departmental DevelopmentIdentifies needs for self-development in patient care and departmental operations.Demonstrates initiative in seeking mentorship and peer consultation.Consistently attends,… more
- Stanford Health Care (Redwood City, CA)
- …area. + Knowledge of basic business aspects of position, such as utilization management , charging practices and regulatory practice compliance. + Knowledge ... of evaluation and treatment methodologies as applied to routine patient care. + Knowledge of legal issues affecting the clinical practice. + Knowledge of pathologies and injuries which result in physical impairments. + Knowledge of principles, methods,… more
- Stanford Health Care (Palo Alto, CA)
- …area + Knowledge of basic business aspects of position, such as utilization management , charging practices and regulatory practice compliance; + Knowledge ... of evaluation and treatment methodologies as applied to routine patient care + Knowledge of legal issues affecting the clinical practice + Knowledge of pathologies and injuries which result in physical impairments + Knowledge of principles, methods, equipment… more