- 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
- Humana (Sacramento, CA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Select Medical (San Diego, CA)
- …functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, ... focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with… more
- Alameda Health System (San Leandro, CA)
- …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... Experience: Three years in a health care field or one year in Utilization Management at a Medical Group or Health plan experience; electronic Health Record (EHR)… more
- Sharp HealthCare (San Diego, CA)
- …nursing experience or case management experience. + 3 Years case management , utilization review , care coordination experience. + California Registered ... position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving… more
- University of Southern California (Los Angeles, CA)
- …multi-task. Preferred Qualifications: + Pref Bachelor's Degree Nursing + Pref 1 year Case management or utilization review experience within the last three ... populations. The RN case manager role integrates the functions of utilization management , quality management , discharge planning assessment, and coordination… more
- Highmark Health (Sacramento, CA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- BeOne Medicines (San Mateo, CA)
- …Resource Management will lead the end-to-end global budget & resource management / utilization within GCO including the development of the Annual Operating ... team on resource-related decisions, including prioritization, hiring, and FSP vendor utilization . + Lead cross-functional resource review forums to optimize… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …Degree in Nursing 4 years nursing in an acute hospital or 2 years Case Management , Utilization Review , or Discharge Planning experience in an acute hospital ... coordinating discharge needs, quality of care, and implementing the utilization management process for acute inpatients. Case... process for acute inpatients. Case Managers perform concurrent review and denials management based on acute… 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