- CommonSpirit Health (Rancho Cordova, CA)
- …leading up to or including supervisory role highly preferred + Experience in Utilization Management , Case Management or Care Coordination, Managed Care ... and communicating with department manager and director the outcomes of the review and any identified issues or barriers. **Accountabilities:** + Compiles data for… more
- Highmark Health (Sacramento, CA)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Highmark Health (Sacramento, CA)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... both internally developed and vendor-sourced criteria. This includes proactive monitoring, review , and timely updates in response to new evidence, regulatory… more
- Humana (Sacramento, CA)
- …health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- Horizon Services, Inc. (Hayward, CA)
- …of front-line support and milieu staff to ensure full census and efficient utilization management at assigned program(s). Engages in marketing, client retention, ... youth prevention, youth and adult outpatient, sobering programs, withdrawal management , and co-occurring capable residential programs to support the well-being… more
- Prime Healthcare (Chula Vista, CA)
- …EDUCATION, EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and ... Responsible for the coordination of the various activities of the Case Management Department under the direction of the assigned Case Manager/Social Worker assist… more
- Dignity Health (Bakersfield, CA)
- …monitoring, and CRM. - Provide backup support to the Medical Director of Utilization Management in medical review activities, peer-to-peer consultations, ... communication, issue resolution, and network expansion. They partner with Network Management and Contracting leadership to support the development of Physician/APP… more
- Prime Healthcare (Chula Vista, CA)
- …EDUCATION, EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and ... development and implementations of discharge plans. Assists with case management referrals and authorizations. Maintains and coordinates Medicaid state submission… more
- Travelers Insurance Company (Sacramento, CA)
- …skills **What is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties ... to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon as medically… more
- Sevita (Eureka, CA)
- …strategy to manage census, maintain occupancy, improve daily attendance, and/or maximize utilization + Financial Management + When applicable, approve purchase ... Home** **Salary - $68,640 per year** Are you an experienced QIDP professional with management ability and the energy and focus to run a thriving Host Home program?… more