- 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
- Centene Corporation (Sacramento, CA)
- …of Certifying Board Service (Internal and Family Medicine, preferred) + Utilization Management experience and knowledge of quality accreditation standards. ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
- CVS Health (Sacramento, CA)
- …+ Human Resource and/or Supervisory experience. + Case management , Utilization Review, or Utilization Management background preferred. **Education** ... am to 8:00 pm Eastern Time.** The Consultant provides management consultation to corporate clients around issues of safety...member clinical assessments and triage into care. Performs case management across scope of all types of management… more
- Evolent (Sacramento, CA)
- …initiatives. **What You Will Be Doing:** + Responsible for oversight of utilization management (UM)/care management (CM) correspondence development, internal ... culture. **What You'll Be Doing:** **Associate Director, Correspondence Project and Program Management ** This position serves a key role in planning, directing, and… 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
- Sharp HealthCare (San Diego, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... policy.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- Providence (Fortuna, CA)
- …in Nursing or health related field. + CCM or ACM + 2 years case management , discharge planning, or utilization management experience in the acute, sub-acute, ... **Description** Care Manager RN - Case Management at Providence Redwood Memorial Hospital in Fortuna,...hospital personnel and outside resources to ensure the appropriate utilization of resources according to clinical and financial standards.… more
- Dignity Health (Rancho Cordova, CA)
- …the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of ... sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management guidelines… more