- Evolent (Sacramento, CA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Stanford Health Care (Palo Alto, CA)
- …initiatives and guidance for product evaluation teams. + Train Value Based Management committee members to analyze and review data effectively during ... trends within health care and academic medical centers that may impact product/service utilization or Value Based Management processes. + Collaborate with key… more
- University of Southern California (Los Angeles, CA)
- …Degree Nursing + Req 5 years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the last three years + ... populations. The role integrates the functions of complex case management , utilization management , quality ...the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate… more
- Cedars-Sinai (Los Angeles, CA)
- …and financial management skills, including effective expense reduction, utilization management , budget control and revenue generation. Compensation Range ... and promote patient safety, continuous performance and quality improvement, risk management , and efficient resource utilization , all linked to evidence-based… 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
- Humana (Sacramento, CA)
- …management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- UCLA Health (Los Angeles, CA)
- …care experience post residency, required + Minimum of 2 years of experience in Utilization Management + 2 or more years of experience working managed care ... team on safe, effective medication use; participate in drug review rounds and P&T Committee. + Contribute to interdisciplinary...+ Knowledge of Medicare Advantage experience with utilization management , quality improvement, or case … more
- Humana (Sacramento, CA)
- …providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial ... + Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard… more
- Cedars-Sinai (Los Angeles, CA)
- …the Foundation, including patient assignment, risk and specialty network structures, and utilization management . Functions as key resource for staff and ... and managing of assigned areas. Works closely with leadership and physician management in the centralized infrastructure development and operations for a specific… more
- CommonSpirit Health (Rancho Cordova, CA)
- …responsibilities leading up to or including supervisory role + Experience in Utilization Management , Case Management or Care Coordination, Managed ... performed and communicating with department manager and director the outcomes of the review and any identified issues or barriers. **Core Duties:** + Compiles data… more