- Evolent (Sacramento, CA)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… 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
- 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)
- …3 years, experience in Case Management in an acute setting or utilization review at a medical group or health plan. Required Licenses/Certifications: Active ... Management provides Care Coordination, Compliance, Transition Coordination, and Utilization Management . **DUTIES & ESSENTIAL JOB FUNCTIONS** NOTE:The… more
- Sharp HealthCare (San Diego, CA)
- …and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management , and concurrent and retrospective rev1ew ... process. + Participates in risk management , pharmacy utilization management , catastrophic case review , outreach programs, HEDIS reporting, site visit … more
- Sharp HealthCare (San Diego, CA)
- …visits and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management , and concurrent and retrospective ... + Participates in risk management reviews. + Assists in pharmacy utilization management , catastrophic case review , outreach programs, HEDIS reporting,… 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
- 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
- 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
- Evolent (Sacramento, CA)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
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