- Dignity Health (Carmichael, CA)
- …efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality ... patient care. + Consults and collaborates with other managers, physicians, administration, and community based healthcare workers regarding care management issues identified through corporate or facility initiatives and current literature \#LI-DH \#CCMSJMC… 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; ... + May interpret and monitor cardiac rhythms depending on area of assignment; and + Performs other related duties as required. Typical Qualifications These are entrance requirements to the examination process and assure neither continuance in the process nor… 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 ... provider or CCS Medical Therapy Unit for patients who may continue to require Physical Therapy services after hospital discharge. **Job Requirements** + Level I: no prior experience required; + Level II: minimum one year experience as a Physical Therapist… 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. + ... Engages in ongoing education and training to stay current with best practices in emergency nursing care. + Performs other related duties as required. Typical Qualifications These are entrance requirements to the exam process and assure neither continuance in… more
- WestCare Foundation (Richmond, CA)
- …staff development, education, and training activities. + Implement Quality Assurance and Utilization Review systems that monitor the effectiveness of the ... treatment system. + Assist in the development of program fiscal and budgetary systems and implementation as well as providing the oversight and management of operating budget and program fiscal expenditures. + Monitor compliance with all required standards,… more
- CVS Health (Sacramento, CA)
- …consistent responses to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides clinical expertise ... and business direction in support of medical management programs through participation in clinical team activities. Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs… more
- WestCare Foundation (San Diego, CA)
- …staff development, education and training activities; + Implement Quality Assurance and Utilization Review systems that monitor the effectiveness of the ... treatment system; + Assist in the development of program fiscal and budgetary tracking systems and implementation as well as providing the oversight and management of operating budget and program fiscal expenditures; + Monitor and ensure compliance with all… more
- Sedgwick (Glendale, CA)
- …and physician filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL ... FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred.… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically… more
- Cognizant (Sacramento, CA)
- …and retro-authorization as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral, preauthorization, medical ... necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and third-party… more