- 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
- 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 ... instruction. May schedule patient appointments.In partnership with physician, may review pre-printed teaching materials or written instructions from the provider… 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
- Elevance Health (Los Angeles, CA)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… 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. + Some awareness ... is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience. The RN Case… more
- Elevance Health (Walnut Creek, 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 ... appeal case reviews with attending physicians or other ordering providers to discuss review determinations. + Serves as a resource and consultant to other areas of… more
- HCA Healthcare (Riverside, CA)
- …Nurse (RN) with current California license required, Case Management Certification or utilization review preferred + Associate's Degree minimum required + ... career path, we encourage you to apply for our Coord Case Mgmt opening. We review all applications. Qualified candidates will be contacted by a member of our team.We… more
- Providence (Napa, CA)
- **Description** Social Worker MSW in Utilization Review Unit at Queen of the Valley Medical Center, CA. This position is Full time and will work 8-hour Day ... Full time **Job Shift:** Day **Career Track:** Clinical Professional **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work… more
- Stanford Health Care (Palo Alto, CA)
- …various problem-solving techniques to deal with technical queries. + Demonstrated ability to review utilization reports and data. + Ability to identify trends ... stratification of at-risk patient populations, acute and skilled nursing facility concurrent review and complex and episodic case management, including the care plan… more
- Select Medical (Los Angeles, CA)
- …+ Coordinates with other departments, ie: Pre-Admissions, Admissions, Patient Accounts, Utilization Review , PPS Coordinator, etc., to assure positive fiscal ... time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and appropriate… more