- Cedars-Sinai (Los Angeles, CA)
- …Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of Joint ... Commission standards and regulatory requirements required Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes required Solid computer proficiency required At Cedars-Sinai, we are dedicated to the safety, health… 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
- 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 These are entrance requirements to the exam process and assure neither continuous in the process nor placement on an eligible list. EDUCATION, TRAINING, and EXPERIENCE: Requires six (6) months… more
- Sedgwick (Sacramento, 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
- Humana (Sacramento, CA)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus ... The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director team to… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- CVS Health (Sacramento, CA)
- …UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience ... a high-volume clinical call center environment. + 1 year of varied UM ( utilization management) experience within an inpatient, concurrent review or prior… more
- Elevance Health (Walnut Creek, CA)
- ** Utilization Management Representative I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person ... Friday, an 8-hour shift between 8 am - 8 pm EST. The ** Utilization Management Representative I** is responsible for coordinating cases for precertification and prior… more
- Banner Health (Susanville, CA)
- …management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process ... including new resident evaluations. Provides verbal and written communication to residents, families and referrals sources regarding the process for admission to the center. Facilitates problem solving with residents, families, referral sources, insurance… more
- CenterWell (Sacramento, CA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more