- Actalent (Sacramento, CA)
- Utilization Review Nurse (LVN) -...ICU). + At least 1 year of experience in utilization review , case management , or hospital ... + Escalate complex or ambiguous cases to the Medical Director or Physician Reviewer . + Ensure complete, accurate, and compliant documentation aligned with CMS and… more
- LA Care Health Plan (Los Angeles, CA)
- …in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The expected pay range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
- Alameda Health System (Oakland, CA)
- …contracted vendors. + Responsible for the coordination and support of the AHS Utilization Review Committee. + Responsible for overseeing patient, physician and ... of financial analyses including cost of care to reimbursement, denials management , and non-reimbursed services, promoting effective resource utilization ,… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as… more
- The County of Los Angeles (Los Angeles, CA)
- …the following: + Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT ... the work of staff, and evaluating employee performance. For this examination, Utilization Review is defined as provides technical and administrative direction… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... provide requested clinical and psychosocial information to assure reimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... delivery and quality of patient care. A hospital-based case management system has as its primary goal to ensure...team members; arranges follow up care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and… more
- Lompoc Valley Medical Center (Lompoc, CA)
- …nursing degree preferred. + Experience: A minimum of two years of clinical experience in Utilization Review or Case Management is preferred. + Per Diem ... systems required. Must demonstrate knowledge of current utilization management principles, third party payor review requirements, age-specific principles,… more
- Ventura County (Ventura, CA)
- …expand, and maintain the pool of eligible service providers. + Utilization review : + Uses professional skills in quality management activities such as ... their journey. THE POSITION: Under direction of a physician or registered nurse , the Field Based Psychiatric Technician performs a variety of paraprofessional… more
- Stanford Health Care (Palo Alto, CA)
- …**Locations** Stanford Health Care **What you will do** + Inpatient & SNF Utilization Management & Care Coordination: + Support proactive hospital discharge ... Provide regular feedback to providers, inpatient case managers, and utilization management coordinators on the appropriateness of...to deal with technical queries. + Demonstrated ability to review utilization reports and data. + Ability… more