- LA Care Health Plan (Los Angeles, CA)
- …the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and ... Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The expected pay… more
- Cedars-Sinai (Beverly Hills, CA)
- …review process. The coordinator works collaboratively with all team members of Utilization Management , Patient and Provider Services, Claims Department and other ... with community resources and social supports required. One (1) year of utilization management or managed care experience preferred. **About Us** Cedars-Sinai… more
- Cedars-Sinai (Beverly Hills, CA)
- …review process. The coordinator works collaboratively with all team members of Utilization Management , Patient and Provider Services, Claims Department and other ... resources and social supports required. + 1 year of previous utilization management or managed care experience; word processing spreadsheet skills also… more
- UCLA Health (Los Angeles, CA)
- …of multiple clinical programs and medical services with an emphasis on optimizing Utilization Management for the Faculty Practice Group (FPG) Management ... in ensuring the delivery of program functionalities in all aspects of Utilization Management and its integration with other patient facing programs within the… more
- Ventura County (Ventura, CA)
- …medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
- Sharp HealthCare (San Diego, CA)
- …to accrediting and regulatory agency feedback. + Supports pre-admission review, utilization management , and concurrent and retrospective rev1ew process. + ... Participates in risk management , pharmacy utilization management , catastrophic case review, outreach programs, HEDIS reporting, site visit review… more
- Elevance Health (CA)
- …services in multiple states. **Preferred Skills, Capabilities, and Experiences:** + Utilization Management experience is strongly preferred. + Health insurance ... initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes....of the utilization reviews within the medical management processes. + Assesses and applies medical policies and… more
- Sharp HealthCare (San Diego, CA)
- …to accrediting and regulatory agency feedback. + Supports pre-admission review, utilization management , and concurrent and retrospective review Process. Performs ... + Participates in risk management reviews. + Assists in pharmacy utilization management , catastrophic case review, outreach programs, HEDIS reporting, site… more
- Evolent (Sacramento, CA)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- Lompoc Valley Medical Center (Lompoc, CA)
- …to the Director of Case Management + Plan, organize and deliver utilization management activities for BOP patients through the LVCHO including authorization ... of services + Deliver utilization management services and social service activities within the acute hospital. + Assist patients with discharge planning and… more