- Centene Corporation (Sacramento, CA)
- …benefits including a fresh perspective on workplace flexibility. Job Description **Concurrent Review Nurse - Remote (California Market | Health Net)** **Centene is ... seeking a** **Remote Concurrent Review Nurse** **to support our** **Health Net California market**...2 years in acute care and managed care, with utilization management experience** **Position Purpose:** Performs concurrent reviews, including… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules ... co-workers and hospital staff. The duties of this position vary widely requiring utilization of different processes and methods to accomplish this work. The work… more
- Gilead Sciences, Inc. (Foster City, CA)
- …change over time, our initial need is for an expert in Material Review platforms (Veeva MedInquiry, VeevaVault, MedDocs, etc). Responsibilities include but are not ... + Hands on experience administering and deploying platforms for Material Review (Veeva MedInquiry, VeevaVault, MedDocs) preferred. + Additional certifications in… more
- John Muir Health (Walnut Creek, CA)
- …of the 340B program. Reports any deficiencies identified during auditing and review for appropriate resolution. + Ensures that the 340B pharmacy program is ... adequate systems checks are reviewed to prevent future billing issues. + Monitors utilization records and 340B purchasing accounts to ensure that software or tools… more
- The County of Los Angeles (Los Angeles, CA)
- …and track the number of departmental contracts requiring the Board of Supervisor's review and approval. + Oversees the review and tracking of department-wide ... databases, status reports, and projected timelines for submission to executive staff for review . + Develops new or modified policies and procedures for completion of… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** As a Utilization Management RN, you will be crucial in ensuring accurate and compliant medical necessity decisions. Your ... reviewing medical records, authorizing services, and preparing cases for physician review . You'll work closely with both Pre-Service and In-Patient Utilization… more
- The County of Los Angeles (Los Angeles, CA)
- …prevention services including but not limited to forecasting utilization and cost, cost/finance analyses, cost-effectiveness analyses, and predictive/prescriptive ... revenue, and to reduce the cost of unnecessary waste and over/under utilization of services. + Conducts predictive data assignments for Behavioral Health Quality… more
- RxBenefits (Los Angeles, CA)
- …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... structure, new prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical vendor/PBM contracts including… more
- University of Southern California (Arcadia, CA)
- …and accurate information to payers. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions. The Case ... meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include: facilitation of… more
- Dairy Farmers of America (Riverside, CA)
- …while maintaining safety, quality and sanitation standards; obtain optimum production and utilization of workforce, machines, and equipment + Review and analyze ... production, quality control, maintenance, and operational reports to ensure compliance and determine causes of non-conformity with product specifications, customer requirements, FDA/government regulations, etc. + Report any non-compliance immediately per… more