- Humana (Sacramento, CA)
- …provider population health programs focused on Stars, HEDIS, MRA, chronic condition management , and other efforts to reduce avoidable utilization * Supporting ... supporting provider performance, and coordinating with cross-functional teams to drive quality, utilization , and cost-of-care outcomes. At the core, this is a role… more
- LACI (Los Angeles, CA)
- …local governments and community-based organizations to deploy, test, and increase utilization of zero emission transportation, clean energy, and sustainable cities ... development, implementation and evaluation of Innovation Pilots to scale the utilization and deployment of cutting-edge clean technology solutions. The Director of… more
- Highmark Health (Sacramento, CA)
- …Benefits, Customer Service, Membership & Billing), Provider Data Management , Underwriting, and Professional Relations. **ESSENTIAL RESPONSIBILITIES** + Provide ... including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making… more
- AECOM (San Francisco, CA)
- …resiliency, equity, and innovation in our projects. **Job Summary/Responsibilities** Knowledge Management : The Regional Architecture Discipline Lead will act as a ... set up tools. + Support operations by balancing architecture utilization and staffing across the region as well as...so. + Experience initiating and maintaining contact with senior-level management within the company and is skilled in dispute… more
- CenterWell (San Diego, CA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. + Responsible for review of the… more
- Sharp HealthCare (San Diego, CA)
- …manage enterprise initiatives that support pharmaceutical contracting, procurement, distribution, utilization and reimbursement in the hospital and ambulatory care ... and performance improvement recommendations for Sharp's Patient Assistance Program.Assisting Management with supervisory responsibilities such as hiring, terminating, coaching,… more
- Sedgwick (Sacramento, CA)
- …use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, trends, and ... advisors as needed; performs complex review of cases to identify referral for case management as needed. + Participates in client meetings and phone calls to explain… more
- Dignity Health (Carmichael, CA)
- …and enhance the clinical credibility of the Care Coordination Department's utilization and compliance activities. + Participate in an annual performance evaluation ... Physician Advisors (Preferred). + Certification in Health Care Quality Management (HCQM) (Required). + Excellent communication, interpersonal, and clinical knowledge… more
- J&J Family of Companies (San Francisco, CA)
- …disease state and product education, and to support HCPs in appropriate utilization of JJIM access and fulfilment resources. The APP-Specialist will compliantly ... and patient care . Deliver on-label product education to support appropriate utilization of company approved products . As needed, deliver unbranded or branded… more
- Meta (Menlo Park, CA)
- …to make informed decisions, particularly in the areas of Meta Capacity Management , efficiency, and ROI analysis. To address this critical company-wide business ... needs, the Capacity Utilization Efficiency and Observability team focuses the following critical areas: resource and usage data acquisition,… more