- 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
- Dignity Health (Glendale, 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
- LA Care Health Plan (Los Angeles, CA)
- Authorization Technician II (ALD) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and… more
- 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