- 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
- Molina Healthcare (San Bernardino, CA)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… 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
- Sharp HealthCare (San Diego, CA)
- …words per minute with 0-2 errors; proof work.Maintain knowledge of insurance, utilization review , scheduling requirements and support of front desk ... policies and procedures.Department specific requirements: all in collaboration with the Nurse Practitioner/referring provider:Wound and Skin Care:* Management of… more
- Sharp HealthCare (San Diego, CA)
- …skills in area of expertise. + Proficient knowledge and understanding of utilization management , case management , healthcare finances, alternative care ... Acute care or clinical experience in area of specialty. + 2 Years Utilization /Case Management experience, preferably in a Managed Care setting. + California… more
- Sharp HealthCare (San Diego, CA)
- …of the manager of in-patient care management and the Director of Utilization Management . **Required Qualifications** + 3 Years Experience in the acute ... Facility/Regional - SCMG Operations meetings and task forces.Facilitate regional Utilization Management committees and other working regional… more
- Highmark Health (Sacramento, CA)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, including … more