- Alameda Health System (Alameda, CA)
- …and a resolution is initiated and presented weekly at Medicare or Utilization Review meetings. **MININUM QUALIFICATIONS** : Education: Graduate of accredited ... school of nursing. Minimum Experience: Minimum one year clinical experience in a hospital, long term care facility, or other healthcare related facility. Preferred Experience: Previous experience as an MDS Coordinator; including completing Minimum Data Set… more
- CVS Health (El Cajon, CA)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients' prescriptions are filled promptly, safely, and accurately, and we are providing caring service that… more
- Sedgwick (Concord, CA)
- …and physician filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL ... FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred.… more
- Ventura County (Ventura, CA)
- …in-services and staff development programs; + May participate in quality assurance/ utilization review or other non-direct patient care nursing assignments; ... and + Performs other related duties as required. Typical Qualifications These are entrance requirements to the exam process and assure neither continuance in the process nor placement on an eligible list. EDUCATION, TRAINING, and EXPERIENCE Requires six (6)… more
- Dignity Health (Merced, CA)
- …efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality ... patient care. **Job Requirements** **Education and Experience:** + Masters Degree in Social Work from a university or college accredited by the Council of Social Work Education. + Minimum of three (3) years in a hospital based Clinical Social Work role,… more
- LA Care Health Plan (Los Angeles, CA)
- …by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health ... Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs. Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric… more
- Dignity Health (Long Beach, CA)
- …when appropriate, discharge planning activities, and coordination with the multidisciplinary team/ Utilization Review Case Manager for referral to a CCS-paneled ... provider or CCS Medical Therapy Unit for patients who may continue to require Occupational Therapy services after hospital discharge. **Job Requirements** _Level I:_ + No prior experience required. _Level II:_ + Minimum one year experience as an Occupational… more
- VNA Health (Santa Barbara, CA)
- …inservice and nursing staff meetings. + Participate in Quality Management and Utilization Review Activities. + Maintain necessary records and reports in ... a timely manner. + Applies working knowledge of state, federal local and accreditation regulations for the delivery of hospice services. + Completes, maintains and submits accurate and relevant clinical notes regarding patient's condition. Records pain,… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …documentation of admissions to the Business Office, Admitting Unit and the Utilization Review Department. + Maintains knowledge of developmental tasks and ... sociological theories of pertinent age groups. + Maintains knowledge of legal guidelines pertaining to Emergency Medical Treatment & Labor Act (EMTALA)/Consolidated Omnibus Budget Reconciliation Act (COBRA) and abuse/neglect reporting. + Communicates with… more
- Ventura County (Ventura, CA)
- …and patient care as indicated and required. + May participate in quality assurance/ utilization review or other non-direct patient care nursing assignments. + ... Performs other related duties as required. Typical Qualifications These are entrance requirements to the exam process and assure neither continuous in the process nor placement on an eligible list. EDUCATION, TRAINING, and EXPERIENCE: Requires six (6) months… more
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