- Alameda Health System (Oakland, CA)
- …overall Case Management functions. + Works closely with the VP of Care Management and Physician Advisors on any audits and secondary reviews; may include but ... of financial analyses including cost of care to reimbursement, denials management , and non-reimbursed services, promoting effective resource utilization ,… 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
- HCA Healthcare (Riverside, CA)
- …review/ management + You will consult with facility-level staff regarding delegated utilization management and disease management operations under managed ... ongoing in-service programs to facility medical staff regarding clinical resource management , appropriate documents standards, utilization and quality issues,… more
- 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
- Sharp HealthCare (San Diego, CA)
- …to accrediting and regulatory agency feedback. + Supports pre-admission review, utilization management , and concurrent and retrospective rev1ew process. + ... clinical practice of medicine. + Previous experience as a physician executive in a managed care environment, preferably as...Participates in risk management , pharmacy utilization management , catastrophic… 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
- Providence (Santa Rosa, CA)
- … management , medical staff and medical center personnel. Provides payor/ utilization review organizations with concurrent retrospective utilization review ... **Description** Care Manager RN - Case Management at Providence Santa Rosa Memorial Hospital in...center personnel and outside resources to ensure the appropriate utilization of resources according to clinical and financial standards.… more
- Sutter Health (Modesto, CA)
- …the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager, Medical Social Worker and bedside RN to assure ... of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through… 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
- 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