- 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
- UCLA Health (Los Angeles, CA)
- …well as oversight of clinical programming, adherence to department budget, ongoing review of purchasing and utilization of personnel resources, compliance with ... policies, standard operating procedures, and maintenance of staff morale and a healthy department culture, and other roles and functions at the discretion of the Associate Chief. You will cultivate a collegial, professional, cooperative relationship with… more
- Stantec (Los Angeles, CA)
- …to enhance our reputation and drive revenue. - Establish an effective Go/No Go Review process with Principals and track compliance. - Partner with other BCPLs and ... maintained and monitor to optimize business development plans and employee utilization rates. - Maintain and enhance local marketplace reputation through established… more
- Stantec (Sacramento, CA)
- …to enhance our reputation and drive revenue. - Establish an effective Go/No Go Review process with Principals and tracks compliance of Go/No Go Process - Partners ... maintained and monitor to optimize business development plans and employee utilization rates - Ensure local marketplace reputation through established relationships… more
- Sharp HealthCare (San Diego, CA)
- …improve clinical outcomes including responsibilities relating to leading teams in the utilization of Change Acceleration Process and PI tools and providing feedback ... issues through measurement and analysis along with concurrent and retrospective review of performance information. Assists with operational planning and development… more
- Humana (Sacramento, CA)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all… more