- Insight Global (Los Angeles, CA)
- …practice is preferred. Experience in chronic disease management , case management , utilization management and quality improvement projects. Bilingual ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/. Skills and… more
- Actalent (Sacramento, CA)
- …experience (eg, med-surg, telemetry, ICU) + At least 1 year of experience in utilization review , case management , or hospital discharge planning + ... within 50 miles of the Sacramento area Job Duties + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and discharges + Apply CMS… more
- Wolters Kluwer (Sacramento, CA)
- …customer relationships to retain and grow existing commercial customer base + Review account utilization management reporting and provide recommendations ... The Sr. Strategic Account & Relationship Management Executive will be responsible for managing and...product value proposition and solution design + Develop and review implementation scope + Coordinate with Sales Operations team… more
- Elevance Health (Los Angeles, CA)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... and outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses appropriate screening… more
- LA Care Health Plan (Los Angeles, CA)
- …multi-departmental (Member Services, Product Network Operations (PNO), Claims, Utilization Management (UM), Pharmacy, Medicare Enrollment/Disenrollment, Sales ... translations for members' correspondence into the appropriate languages. As requested review documents submitted by C&L to ensure proper translation and culturally… more
- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/237903/rn-case-manager utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... and service! Responsibilities Responsible for the quality and resource management of all patients that are admitted to the...to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
- Highmark Health (Sacramento, CA)
- …expertise.This may include updating/revising existing medical policies. + Partner with Utilization Management and other operational teams to identify ... by internal/external partners. Conducts peer reviews as part of the quality review process. In addition to policy ownership, the incumbent participates in various… more
- Sharp HealthCare (Santee, CA)
- …all notes and billing daily.Completes all tasks and documentation needs (ie utilization management , plan of care, medical necessity reviews) based on ... requirements.PT Spec II additional standardsSupports clinic needs for documentation review and training. + Professional and Departmental DevelopmentIdentifies needs… more
- Three Saints Bay (Port Hueneme, CA)
- …or managerial functions + Two (2) years of experience directly related with utilization of Content Management Systems, learning Management Systems, and/or ... (R&M) Modeling, Prediction, Allocation and Analysis for program evaluations, review , or implementation. **Desired Qualifications:** + Demonstrated experience analyzing… more
- Elevance Health (Costa Mesa, CA)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care… more