- Cedars-Sinai (Beverly Hills, CA)
- …for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to ... reporting to the TPL carrier of all injured worker cases receiving case management services. + Ensures appropriate utilization of medical services within the… more
- Cedars-Sinai (Beverly Hills, CA)
- …years of acute nursing experience required + 3 years of previous experience in case management , discharge planning, utilization review , and HMO in the acute ... Case Manager will assist in the daily operations of the inpatient case management department. Primary responsibility is to provide oversight of the daily functions… more
- Cardinal Health (Sacramento, CA)
- …risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, CMS ... of audit results to physicians, physician leadership, senior leadership, management , and staff; physician and coder education; and the...revenue cycle team in identifying the time period of review and conducts a focused audit to identify any… 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 ... that the class requires more independent action in the promotion and utilization of effective mental health techniques. PAYROLL TITLES & SALARIES: Psychiatric… more
- Banc of California (San Diego County, CA)
- …procedures and state and federal regulations. + Effectively executes on contact management strategy through utilization of available tools and resources ... Regularly meets with internal business partners to communicate and review business results and pipeline management . +...communicate and review business results and pipeline management . + Treat people with respect; keep commitments; inspire… more
- Providence (CA)
- …in a medical record. + 2 years - HEDIS, Quality management /quality improvement/ utilization review auditing experience, including experience ... Health Information Management degree. + Experience with health plans, project management , data analysis, and/or case review . **Why Join Providence?** Our… more
- STG International (Victorville, CA)
- …in quality improvement, care management , risk management , peer review , utilization review , clinical outcomes, and health enhancement activates. ... of Quality Performance Improvement Team (QPIT) strategic initiatives. *Participate in review and improvement of clinical success in of areas of responsibility.… more
- Northrop Grumman (San Diego, CA)
- … Review Change Requests, as required, and provide impacts to IFC management + Manage asset utilization for IFC-specific asset, deconflicting between internal ... + Lead IFC execution and delegation of tasks. + Review System Test deliverables during procedure release cycles. +...during Formal execution. + Attend daily and weekly IFC management and customer meetings, representing the System Test Software… more
- SAIC (El Segundo, CA)
- …engineering and/or technical problems regarding operations, staffing, and equipment utilization on a specific project or projects. Provides technical assistance ... other engineers and technical personnel, with completed assignments subject to minimum review of overall results. Trains, directs, and assists the efforts of other… 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
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