• Health Information Management (HIM)…

    City and County of San Francisco (San Francisco, CA)
    …timely coding and compliance with regulatory requirements in coordination with Utilization Management , Patient Financial Services, and Revenue Integrity. + ... and direction for multiple clinic-wide functions within the Health Information Management (HIM) - Mid Revenue Cycle Department, overseeing key functions that… more
    City and County of San Francisco (10/11/25)
    - Related Jobs

  • SRS - Case Manager - Population Health -Copley…

    Sharp HealthCare (San Diego, CA)
    …skills in area of expertise. + Proficient knowledge and understanding of utilization management , case management , healthcare finances, alternative care ... clinical experience in area of specialty. + 2 Years Utilization /Case Management experience, preferably in a Managed...the first 12 hours of data to complete admission review .Documents assessment and IQ/guideline review data per… more
    Sharp HealthCare (10/16/25)
    - Related Jobs

  • Supv Regional Care Mgmt- Integrated Care Mgmt…

    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
    Sharp HealthCare (10/07/25)
    - Related Jobs

  • Assistant Nursing Director, Administration

    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
    The County of Los Angeles (10/18/25)
    - Related Jobs

  • UM Prior Authorization Review Nurse - RN

    UCLA Health (Los Angeles, CA)
    Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... + A minimum of three years of experience in utilization management , preferred + Team leading or...+ Working knowledge of laws, rules, and regulations regarding utilization review and discharge planning functions of… more
    UCLA Health (10/03/25)
    - Related Jobs

  • Formulary Operations Management…

    Humana (Sacramento, CA)
    …Clinical Drug Policy Management team which ensures synchronization of formulary utilization management policies across multiple systems. Humana is seeking a ... and maintenance of clinical tools which help facilitate clinical medication review decision making. + Responsible for operationalizing prior authorization criteria… more
    Humana (10/18/25)
    - Related Jobs

  • Field Medical Director- (MD/DO)

    Evolent (Sacramento, CA)
    …**What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (09/26/25)
    - Related Jobs

  • Field Medical Director, Oncology

    Evolent (Sacramento, CA)
    …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (08/19/25)
    - Related Jobs

  • Care Manager, Registered Nurse

    Sutter Health (Roseville, CA)
    …SMCS-Valley Administration **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the ... and at the appropriate level of care. Coordinates the utilization management , resource management , discharge...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
    Sutter Health (09/26/25)
    - Related Jobs

  • Inpatient Concurrent Review RN

    Dignity Health (Woodland, CA)
    …- Three (3) years acute care or related experience including experience in case management , utilization review or discharge planning. - Clear and current ... barriers are identified assists the patient family caregiver care coordination with Utilization management as related to referrals. - Considers the population… more
    Dignity Health (10/02/25)
    - Related Jobs