- Dignity Health (Los Angeles, CA)
- …90 days of hire. + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... emphasis will be on care coordination communication and collaboration with utilization management nursing physicians ancillary departments insurers and post acute… more
- Sutter Health (San Francisco, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Working ... Med Center - Mission Bernal **Position Overview:** Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute… more
- Highmark Health (Sacramento, CA)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Elevance Health (Corona, CA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more
- UCLA Health (Santa Monica, CA)
- …patients with discharge/post-hospital care + Interacting with hospital departments such as Utilization Review and Patient Business Services to ensure correct and ... agencies * Knowledge in the functional operations of third party payers and utilization review agencies to expeditiously coordinate follow-up * Working knowledge… more
- Elevance Health (Walnut Creek, CA)
- …with providers and external physicians. + Applies clinical knowledge and skills to utilization review processes. + Adheres to medical policies and clinical ... be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military… more
- Elevance Health (CA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... Medicaid operations by providing clinical leadership and oversight across utilization management, appeals, and program innovation. This position ensures timely,… more
- UCLA Health (Los Angeles, CA)
- …patients with discharge/post-hospital care + Interacting with hospital departments such as Utilization Review and Patient Business Services to ensure correct and ... agencies + Knowledge in the functional operations of third party payers and utilization review agencies to expeditiously coordinate follow-up + Working knowledge… more