- Sutter Health (San Francisco, CA)
- …Manager is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience. The ... case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness… 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
- 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
- Pomona Valley Hospital Medical Center (Pomona, CA)
- …or equivalent education necessary to meet licensure requirements. One year experience in Utilization Review or Case Management discharge planning, current ... the Case Management Department. The LVN within the Utilization Management team collaborates closely with Case Managers, support staff, insurance payers,… more
- Abbott (Alameda, CA)
- …and accountability across business domains to support ethical and effective data utilization . **Demand/Intake Management ** + Build deep relationships with our ... disease-state and live life to the fullest. As the IT Director Business Relationship Management - Global Data Analytics, you will play a pivotal role in advancing… more
- UCLA Health (Los Angeles, CA)
- …medical leadership experience, required + Minimum of 2 years of experience in Utilization Management , required + Minimum of 2 years in developing evidence-based ... within a health plan, required + Knowledge of Medicare Advantage experience with utilization management , quality improvement, or case management , required +… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …RN possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... absence of the incumbent. 6. Plan and document care and resource utilization , accounting of maximum staff productivity, staff/time efficiency, and positive patient… more
- UCLA Health (Los Angeles, CA)
- …of safe, high quality, efficient, and cost-effective care. You will also perform utilization review while assuring the delivery of concurrent and post-hospital ... + CA RN License and BLS certification + Recent experience in case management , utilization management and discharge planning + Minimum of three years of… more
- Humana (Sacramento, CA)
- …health initiatives. + Collaborate with various operational functions in the centralized utilization management team and other shared services. + Participate in ... data (eg Quality measures, Risk Adjustment ratings, chronic condition management , PCP visit rates and effectiveness, and member engagement...quality governance, peer review , and grievance resolution processes. Innovation & Transformation: +… more
- Elevance Health (Walnut Creek, CA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... Capabilities and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience.… more
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