- CVS Health (Sacramento, CA)
- …plan medical directors. + Attend and participate in clinical meetings with care management and utilization management . Provide subject matter expertise on ... the direction of the Lead Clinical Psychologist, this position will focus on utilization , quality, and review of fraud, waste, and abuse for individual Aetna member… more
- Cedars-Sinai (Los Angeles, CA)
- …of the Foundation, including patient assignment, risk and specialty network structures, and utilization management . Functions as a key resource for staff and ... duties. + Serves as liaison for areas of operational responsibility with facilities management , patient billing, utilization management , quality, risk, human… more
- Elevance Health (Fresno, CA)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... integrated care plan, engaging the member's circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS needs, as… more
- Ross Stores, Inc. (Dublin, CA)
- …contracts, identifies embedded leases and applies proper accounting treatment for management utilization in decision making process\. * Drive cross\-functional ... and methodology\. * Analyze and interpret of the financial results for management 's utilization in business decision\-making processes\. Responsible for monthly… more
- Gilead Sciences, Inc. (Santa Monica, CA)
- …and demand reporting + Stakeholder communication + Risk assessment & mitigation + Utilization of project management core principles (PMP certification a plus) + ... **Job Description** + The **Senior Manager, Planisware Clinical Trial Planning, Resource Management , and Reporting** is a member of the Portfolio, Project … more
- Molina Healthcare (Los Angeles, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
- CVS Health (Sacramento, CA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....lower levels of care. + 1+ years' experience in Utilization Review. + CCM and/or other URAC recognized accreditation… more
- Humana (Sacramento, CA)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a… more
- LA Care Health Plan (Los Angeles, CA)
- …Functional knowledge of HEDIS, HIE, Health Analytics required. Functional knowledge of Utilization Management , Care Management , Clinical Case Management ... (eg Clinical Care Advance, ZeOmega, Altruista, Thrasys) required. Functional knowledge of Utilization Management , Care Management , Clinical Case … more
- Providence (Tarzana, CA)
- …communication and care coordination along a continuum through effective transitional care management and utilization management . Recognizing the patient's ... Ambulatory, Post-Acute, etc.) + 2 years Experience in Case Management (Care Coordination or Utilization Management...Experience in Case Management (Care Coordination or Utilization Management ) or successful completion of the… more