- Cognizant (Sacramento, CA)
- …+ Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Excellent problem-solving skill in ... team and collaborate with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper or EDI… more
- Sharp HealthCare (San Diego, CA)
- …response to therapeutic interventions via collateral calls, conjoint therapy sessions, utilization review process, and/or referrals and revises care plan ... issues.Identifies Bioethical dilemmas and initiates appropriate response.Testifies at Certification Review and Reise hearings regarding patient's current mental health… more
- Cedars-Sinai (Marina Del Rey, CA)
- …the established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review for ... identified contracted/private patients collaborates with on-site and/or outside reviewers. + Keeps patients informed of progress and provides information related to disease progression. + Collaborates with discharge planner to make orders and arranges for home… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …knowledge and skills in areas of risk management, infection control, and utilization review . + Current knowledge of continuous quality improvement methodology. ... Monitors staff completion of mandatory annual competencies, including CPR, HWC, safety review , and code of conduct. + Collaborates with administration to assess… more
- Ventura County (Ventura, CA)
- …in-services and staff development programs; + May participate in quality assurance/ utilization review or other non-direct patient care nursing assignments; ... receive a sufficient number of qualified applications to meet business needs. FIRST REVIEW OF APPLICATIONS: July 15, 2025 Examples Of Duties Duties include but are… more
- Dignity Health (Merced, CA)
- …efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality ... patient care. **Qualifications** **Education and Experience:** + Masters Degree in Social Work from a university or college accredited by the Council of Social Work Education. + Minimum of three (3) years in a hospital based Clinical Social Work role,… more
- CVS Health (Richmond, CA)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients' prescriptions are filled promptly, safely, and accurately, and we are providing caring service that… more
- Cognizant (Sacramento, CA)
- …experience. + Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Must be able to work with ... minimal supervision. + Good skills at problem resolution specifically related to healthcare claim adjudication. + Possess ability to work at a computer for extended periods. + Can work closely with other departments **Required Education and Experience** + High… more
- Dignity Health (Stockton, CA)
- …Center and other hospitals and agencies who serve as referral sources, including utilization review and managed care companies. This position requires providing ... service to a one or more age populations including a child, adolescent/teen, adult and geriatric patient population. This position requires the full understanding and active participation in fulfilling the Mission of the Organization. It is expected that the… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... responsibilities.Able to operate and maintain department equipment. **Knowledge, Skills, and Abilities** + IV proficient. Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment… more