- Elevance Health (Walnut Creek, CA)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... 8:35 AM to 5:05 PM Pacific. Training hours may vary. The ** Utilization Management Representative I** is responsible for coordinating cases for precertification and… more
- Prime Healthcare (Montclair, CA)
- …the Case Management Department under the direction of the assigned Case Manager /Social Worker assist with development and implementations of discharge plans. Assists ... EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions, in both… more
- CenterWell (Sacramento, CA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare +… more
- Rady Children's Hospital San Diego (San Diego, CA)
- JOB SUMMARY: Under the supervision of the UM Operations Manager , the UM Operations Trainer's primary job function is to support Utilization Management operations ... equity. This posting will remain open from the "date posted" until the hiring manager has determined there is a sufficient applicant pool or until the position is… more
- Amergis (Santa Rosa, CA)
- The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service ... delivery, and compliance with medical regime. Minimum Requirements: + Current RN licensure in state practicing + At least one year of Case Management experience preferred + Current CPR if applicable + TB questionnaire, PPD or chest x-ray if applicable +… more
- Griffith Company (San Diego, CA)
- …methods and sequence of operations. + Coordinate manpower and equipment utilization . + Assist project manager in conducting effective ... specifications. + Direct and supervise foreman. + Coordinate with Project Manager /Project Engineer/Estimator. + Supervise and update the project schedule. + Interact… more
- Sharp HealthCare (San Diego, CA)
- …care, SNF, home health, or hospice settings. + Experience as a case manager or discharge planner interacting with managed care payers. + Experience with InterQual ... stay beginning with the admission review of the case manager and reviews with the Case Manager Lead, as needed.Keeps SRS Leadership informed of any adverse… more
- Providence (Mission Hills, CA)
- …all meetings attended by Administrative Director of Managed Care, Contract Manager , Case Managers and UM supervisors. Provides vacation coverage for Executive ... Administrative Assistant duties as assigned. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment,… more
- Dignity Health (Long Beach, CA)
- …when appropriate, discharge planning activities, and coordination with the multidisciplinary team/ Utilization Review Case Manager for referral to a CCS-paneled ... general guidance of the Director of Rehabilitation Services and Therapy Manager ; the Physical Therapist administers patient evaluations, plans and implements patient… more
- Amergis (Orange, CA)
- … Manager to help support a health insurance agency! The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing ... as those listed above may also be qualifying. Preferred Qualifications: + Utilization management reviewer experience. + Managed care experience. + Behavioral health… more