- Highmark Health (Sacramento, CA)
- …drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide recommendations for NDC ... not limited to: prior authorization, dose and duration edits, quantity limits, step- care edits, generic sampling medical policy review and development, member… more
- The County of Los Angeles (Los Angeles, CA)
- …techniques and methodologies to analyze large-scale service utilization data (eg, service utilization by CPT codes, level of care , and provider type, and ... to make better financial, business, policy and operational decisions in managing costs, utilization , and quality of care as well as financial risk management.… more
- Cedars-Sinai (Beverly Hills, CA)
- …+ Processes Extensions and Denial Letters, when needed. + Prepares Utilization Review Reports as needed. + Assists the Case/ Care Managers in coordinating and ... **Job Description** The Case Management Coordinator provides support to the utilization review process. The coordinator works collaboratively with all team… more
- Genesis Healthcare (Elk Grove, CA)
- …department, including oversight related to case management, quality improvement, care planning, clinical utilization , and patient identification is ... assisted and independent living facilities, outpatient clinics, and home-based care . We're proud to deliver personalized care ...or coordinating the timely completion of the annual merit review for therapy staff. 6. Assists in management of… more
- General Dynamics Information Technology (Coronado, CA)
- …as assigned by the HP program Manager and/or Coordinator. + Documents care provided, work performed, utilization , referrals, and all other information in the ... scope of practice. + Participates in periodic meetings to review the care provided to patients to...improvement. + Serves as advisor to the HP program Manager and/or Coordinator in matters related to injury prevention,… more
- Elevance Health (Corona, 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 ... health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to… more
- Elevance Health (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 ... Medicaid operations by providing clinical leadership and oversight across utilization management, appeals, and program innovation. This position ensures timely,… more
- KBR (Coronado, CA)
- …as assigned by the HP program Manager and/or Coordinator. + Document care provided, work performed, utilization , referrals, and all other information in the ... scope of practice. + Participate in periodic meetings to review the care provided to patients and...+ Serve as an advisor to the HP program Manager and/or Coordinator in matters related to injury prevention,… 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 ... health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to… more
- CommonSpirit Health (Rancho Cordova, CA)
- …for completing quality assurance reviews of work performed and communicating with department manager and director the outcomes of the review and any identified ... responsibilities leading up to or including supervisory role + Experience in Utilization Management, Case Management or Care Coordination, Managed Care… more