- Sutter Health (Berkeley, CA)
- …Overview:** Accumulates, interprets, and documents timely information to justify acute hospital admission , need for continued stay, and proper utilization of ... with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of… more
- Datavant (Sacramento, CA)
- …The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... well versed in DRG downgrade denials and appeal writing for inpatient admission . Experience with clinical criteria resources and payor guidelines. **You will:** +… more
- Sharp HealthCare (San Diego, CA)
- …with contracted health plan requirements for documentation of concurrent SNF review and utilization management activities performed in a manner ... our recruitment and hiring teams. **What You Will Do** To provide comprehensive utilization management and coordination of care for members who are confined to… 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
- Sharp HealthCare (San Diego, CA)
- …discharge.* Complete Inpatient admission notification for urgent or planned admissions . Coordinate with the Utilization Management department to facilitate ... + Working knowledge in the functional operations of third-party payors and utilization review agencies to expeditiously coordinate follow-up. + Working knowledge… more
- Cedars-Sinai (Beverly Hills, CA)
- …for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to ... their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered and to ensure… 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
- ERP International (Camp Pendleton, CA)
- …patient safety by monitoring and tracking the enrolled population for hospital admissions and emergent/urgent utilization , making contact with the patient, ... manuals, reports and actively engages patients in their health care. + Review details and expectations regarding referrals with patients. + Provide support to… more