- LA Care Health Plan (Los Angeles, CA)
- …and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The ... include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to assist… more
- Genesis Healthcare (Willows, CA)
- …Clinical Operations Area Director in the timely completion of the annual merit review for therapy staff. 7. Assists Clinical Operations Area Director in the hiring ... 8. Participates in and coordinates the timely completion of the annual merit review for therapy staff. 9. Assumes responsibility for hiring therapy staff (in… more
- Rubrik (Palo Alto, CA)
- …global Professional Services financial goals, including top-line revenue targets, utilization rates, and overall profitability across all assigned territories. ... on key performance indicators (KPIs) and global operating metrics (eg, utilization , CSAT, time-to-value, time to deploy). + **Strategic Partner Ecosystem:**… more
- Stantec (Irvine, CA)
- …range of market sectors that leads to an expected 60% direct utilization - Primary point-of-contact for planning-related pursuits, inputs to operational and business ... selling of services - Track and manage the planning group's overall utilization in collaboration with supervisors including identifying key leads and support staff… more
- Genesis Healthcare (Elk Grove, CA)
- …of Rehab with conducting or coordinating the timely completion of the annual merit review for therapy staff. 6. Assists in management of therapy staff. 7. Assists in ... daily staffing and utilization in cooperation with input from treating therapists, consideration...of the highest standard of rehabilitation services through appropriate utilization of resources, the promotion of clinical programs, and… more
- Highmark Health (Sacramento, CA)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Sevita (Eureka, CA)
- …funds and property; assure security and accuracy; audit, monitor, and review individual's financial accounts + Implement proactive strategies to reduce or ... safety concerns and limit the potential for continued concern or incident; review all incidents and direct appropriate response; ensure timely incident reporting +… more
- Sharp HealthCare (La Mesa, CA)
- …required within 90 days of hire. **Essential Functions** + Verification and review of medication orders-Reviews all medication orders for appropriate dose, duration, ... protocols and consultation with the interdisciplinary team.-Completion of a daily profile review for each patient consisting of the following elements:* Age, sex,… more
- The County of Los Angeles (Los Angeles, CA)
- …solicitations and contracts are developed pursuant to best practices. Review contracting opportunities with applicability to Community-Based Organizations (CBOs), ... and advertisements are provided and facilitate opportunities for competition. Review Department solicitation practices to provide strategic recommendations and… 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
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