- Dignity Health (Glendale, 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
- Elevance Health (Walnut Creek, CA)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in ... and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens and… 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
- University of Southern California (Los Angeles, CA)
- …+ Req 5 years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the last three years + Req Ability to work ... The role integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of… more
- Actalent (Sacramento, CA)
- …(eg, med-surg, telemetry, ICU) + At least 1 year of experience in utilization review , case management, or hospital discharge planning + Familiarity with ... within 50 miles of the Sacramento area Job Duties + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and discharges + Apply CMS… more
- UCLA Health (Los Angeles, CA)
- …external, to assist patients with discharge/post hospital care + Interact closely with Utilization Review and Patient Business Services to ensure correct and ... + Working knowledge in the functional operations of third party payors and utilization review agencies to expeditiously coordinate follow-up + Working knowledge… more
- Ventura County (Ventura, CA)
- …that establish, expand, and maintain the pool of eligible service providers. + Utilization review : + Uses professional skills in quality management activities ... such as utilization review , monitoring and evaluation procedures, and the development of standards and protocols. + Performs other duties as required… more
- Sharp HealthCare (La Mesa, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... instruction. May schedule patient appointments.In partnership with physician, may review pre-printed teaching materials or written instructions from the provider… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …Nursing 4 years nursing in an acute hospital or 2 years Case Management, Utilization Review , or Discharge Planning experience in an acute hospital PREFERRED ... includes coordinating discharge needs, quality of care, and implementing the utilization management process for acute inpatients. Case Managers perform concurrent … more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- …financial system. This position requires a strong understanding of payer policies, utilization review workflows, admission criteria, and hospital revenue cycle ... or equivalent. Three years' experience in patient access, hospital admissions, utilization review , or insurance authorization. Strong communication, critical… more