- Sharp HealthCare (San Diego, CA)
- …in-patient Care Management program that includes initial and concurrent review ; case management/discharge planning activities. Responsible for operational planning ... of the manager of in-patient care management and the Director of Utilization Management. **Required Qualifications** + 3 Years Experience in the acute patient… more
- Dignity Health (Bakersfield, CA)
- …as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the adverse ... of defined levels of hierarchy and composition of compliant denial notices to review medical records, authorize requested services and prepare cases for physician … more
- Stantec (Santa Maria, CA)
- …are actioned. - Regularly monitors forecasting, backlog, EVA, WIP, AFDA, DSO and utilization to identify issues and ensure they are addressed. - Responsible for ... office matters including employee relation issues - Responsible for achieving utilization rate and backlog targets including collaboration with other contributing… more
- Stantec (Petaluma, 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
- BrightView (San Fernando, CA)
- …provides direct support to branch leadership to drive optimal equipment utilization , vendor performance, and compliance with company standards. You'd be responsible ... increase rebate flow-through, and reduce capital expenditures. 3) Operational Support & Utilization + Analyze equipment utilization across branches to identify… more
- Ventura County (Ventura, CA)
- …areas of responsibility include, but are not limited to, compliance review , budgeting, grant accounting, cost accounting and financial analysis/reporting duties. At ... rates based on analysis of complex cost components, past utilization trends and impact on fund balances or retained...retained earnings. + Learns to compile, analyze, adjust and review (Accountant I) or complies, analyzes, adjusts and reviews… more
- Humana (Sacramento, CA)
- …the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in a medical management review organization, ... 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
- LA Care Health Plan (Los Angeles, CA)
- …with internal departments (Member Services, Provider Network Operations, Claims, Utilization Management, Pharmacy, and Quality Management) to ensure the use ... member correspondence for accuracy, clarity, and cultural appropriateness and sensitivity. Review grievance and State Fair Hearing files for compliance with Policies… more
- Highmark Health (Sacramento, CA)
- …Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, state, CMS, ... to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and files, delivering… more
- 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