- Humana (Sacramento, CA)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- Alameda Health System (San Leandro, CA)
- …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... Required Experience: Three years in a health care field or one year in Utilization Management at a Medical Group or Health plan experience; electronic Health Record… more
- Emanate Health (Glendora, CA)
- …for performing clinical consults according to pharmacy guidelines and conducting ongoing drug utilization review to promote effective, safe and efficient use of ... medications. Supervises technicians to optimize workflow and resource utilization . Actively participates in CQI activities. **Job Requirements** **Minimum Education… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... meet service standards. Follows policy and procedure for entering of OCM and utilization of IDX. Completes work within assigned hours.Able to respond to changing… more
- The County of Los Angeles (Los Angeles, CA)
- …NICU, Burn ICU), Oncology, Parenteral Nutrition, Ambulatory Care, Drug Utilization Review , Anti-Coagulation, Purchasing Consultant, Drug Information, ... by assisting in the establishment of criteria for cost effectiveness/control utilization use, process indicators, and monitoring parameters; conducts evaluations to… more
- Dignity Health (Arnold, CA)
- …services provided; participate in annual review of patient health records and utilization review studies of the Clinic services + Maintain confidentiality of ... records are transferred as required when patients are referred; participate in an annual review for quality completeness + Is present in the Clinic at least once… more
- STG International (Victorville, CA)
- …patient safety. *Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health ... of Quality Performance Improvement Team (QPIT) strategic initiatives. *Participate in review and improvement of clinical success in of areas of responsibility.… more
- Elevance Health (Los Angeles, 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
- Providence (CA)
- …in a medical record. + 2 years - HEDIS, Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and pharmacy records… more
- University of Southern California (Arcadia, CA)
- …Minimum of three years' experience in clinical disciplines (RN, MD, FMG) or utilization review /case management in an acute care facility, with clinical ... and other clinical staff. + Meets established productivity targets for record review and appropriate query placement. + Demonstrates working knowledge of ICD-10 CM… more