- Sharp HealthCare (San Diego, CA)
- …appeals and grievances. **Required Qualifications** + 3 years' experience in claims, utilization review , appeals or member services in a managed care ... environment **Preferred Qualifications** + Bachelor's Degree Business Administration or Health Care Administration (including courses of study in accounting, finance, marketing, and health care administration) **Essential Functions** + Appeal and grievance… more
- Ventura County (Ventura, CA)
- …and patient care as indicated and required. + May participate in quality assurance/ utilization review or other non-direct patient care nursing assignments. + ... Performs other related duties as required. Typical Qualifications Education/Experience: Requires six (6) months of recent full-time acute care registered nursing experience in an acute hospital or equivalent setting, or completion of the Ventura County Medical… more
- Stanford Health Care (Palo Alto, CA)
- …program team. + Develops and maintains professional relationships with insurance carrier's utilization 's review managers in order to complete authorizations in a ... timely manner. + Tracks and maintains records of interaction with all physician consultants utilized by the transplant departments as necessary. Adheres to transplant policies and procedures as related to financial clearance issues set forth by senior… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …documentation of admissions to the Business Office, Admitting Unit and the Utilization Review Department. + Maintains knowledge of developmental tasks and ... sociological theories of pertinent age groups. + Maintains knowledge of legal guidelines pertaining to Emergency Medical Treatment & Labor Act (EMTALA)/Consolidated Omnibus Budget Reconciliation Act (COBRA) and abuse/neglect reporting. + Communicates with… more
- UCLA Health (Santa Monica, CA)
- …+ Knowledge in the functional operations of third-party payors and utilization review agencies to expeditiously coordinate follow-up. + Interpersonal ... skills to interact with all members of the healthcare team to develop and maintain a cooperative working environment. UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or… more
- VNA Health (Santa Barbara, CA)
- …inservice and nursing staff meetings. + Participate in Quality Management and Utilization Review Activities. + Maintain necessary records and reports in ... a timely manner. + Applies working knowledge of state, federal local and accreditation regulations for the delivery of hospice services. + Completes, maintains and submits accurate and relevant clinical notes regarding patient's condition. Records pain,… more
- Dignity Health (Folsom, CA)
- …knowledge of pharmaceutical care distribution systems + Knowledge of drug utilization review , quality improvement techniques, pharmacy automation + Understanding ... of California Title 22 regulations pertaining to provision of pharmaceutical care in acute care, long-term care, sub-acute care, and psychiatric care + Knowledge of the principles of adult learning skills training. This position shall demonstrate behaviors… more
- Sutter Health (Yuba City, CA)
- …of recent relevant experience. **SKILLS AND KNOWLEDGE:** + Knowledge of Drug Utilization Review Procedures and Therapeutic Drug Monitoring. + Demonstrated ... working and administrative understanding of outpatient and unit dose dispensing, IV admixture compounding, and other inpatient and clinical programs. + Ability to work in a complex and dynamic environment and take appropriate actions in emergent situations. +… more
- Alameda Health System (San Leandro, CA)
- …staff, visitors, and volunteers. 8. Assures that the facility complies with all utilization review and case management requirements of Alameda County, AHS, and ... all payers. 9. Collaborates with the JGPH Department Chair and on strategic and clinical alignment. 10. Communicates and collaborates regularly with the Department Chair, administrator, the director of nursing, on strategic and clinical alignment and provides… more
- Alameda Health System (Alameda, CA)
- …and a resolution is initiated and presented weekly at Medicare or Utilization Review meetings. **MININUM QUALIFICATIONS** : Education: Graduate of accredited ... school of nursing. Minimum Experience: Minimum one year clinical experience in a hospital, long term care facility, or other healthcare related facility. Preferred Experience: Previous experience as an MDS Coordinator; including completing Minimum Data Set… more