- Sharp HealthCare (San Diego, CA)
- …of Authorization Review for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions to ensure quality of care and ... appropriate utilization in the most cost-effective, appropriate and professional manner,...of managed care and the process for prior authorization review + California Physicians and Surgeons License - Medical… more
- Sharp HealthCare (San Diego, CA)
- …of Authorization Review for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions to ensure quality of care and ... appropriate utilization in the most cost-effective, appropriate and professional manner,...of managed care and the process for prior authorization review . + California Physicians and Surgeons License - Medical… more
- Ventura County (Ventura, CA)
- …evaluation, and review ; + Performs daily clinical reviews to support utilization and quality management , ensuring compliance with guidelines and standards ... The ideal candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of… more
- Humana (Sacramento, CA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... 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
- Provider Solutions & Development (Mission Hills, CA)
- …of medical group management experience required + Must have working knowledge of utilization management and review essential to operations management ... with, motivate, and assist medical staff leadership to adhere to utilization management , clinical documentation, and other legal/regulatory requirements +… more
- LA Care Health Plan (Los Angeles, CA)
- …adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert ... can include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management , Medical Directors, and other internal teams to… more
- Evolent (Sacramento, CA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- Dignity Health (Long Beach, CA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- Dignity Health (Los Angeles, CA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- Dignity Health (Long Beach, CA)
- …emphasis will be on care coordination communication and collaboration with utilization management nursing physicians ancillary departments insurers and post ... + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more