- Stanford Health Care (Palo Alto, CA)
- …complex needs in collaboration with other interdisciplinary team members; arranges follow up care as appropriate. + Utilization Review -- Reviews ... include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review ...Manager differs from other roles in professional nursing/health care practice in that it is not intended to… 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 ... at-risk patient populations, acute and skilled nursing facility concurrent review and complex and episodic case management, including the... **What you will do** + Inpatient & SNF Utilization Management & Care Coordination: + Support… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... Care (SHC)? Are you a seasoned RN Case Manager ? Here is your opportunity to work with the...requested clinical and psychosocial information to assure reimbursement. + Utilization Review -- Reviews prospectively, concurrently and… more
- LA Care Health Plan (Los Angeles, CA)
- …their authorized representative, the Ombudsman office, state contractors, member advocates, LA Care Board Members, providers, etc. The Manager is responsible for ... Manager , Customer Solution Center Appeals and Grievances Job...Review and monitor procedures for identifying quality of care issues and work collaboratively with multiple departments (Claims,… more
- Sharp HealthCare (San Diego, CA)
- …requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving care in ... level of care ; work closely with ambulatory care manager (ACM) at the system level,...provides information to the department head as indicated. + Utilization review and utilization managementThe… more
- Sutter Health (Modesto, CA)
- …case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care , and observation status. + Awareness ... experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside...to include the achievement of optimal health, access to care , and appropriate utilization of resources balanced… more
- Sutter Health (Modesto, CA)
- …and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care , and observation status. Awareness ... experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside...to include the achievement of optimal health, access to care , and appropriate utilization of resources balanced… more
- LA Care Health Plan (Los Angeles, CA)
- …current and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager ... such as a health insurance environment and/or experience as care manager in home health or hospice...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager… more
- Magellan Health Services (San Diego, CA)
- …and operations. Strong written and verbal communication skills. General Job Information Title Care Manager , Health Plan, Part Time, Licensed/Remote in CA Grade ... effective person-centered care plan, member education and care management. Conducts initial and concurrent review ...of assigned care support teams. Experience with Care Management flows. Knowledge of utilization management… more
- HCA Healthcare (Thousand Oaks, CA)
- …of care in 21 states and the United Kingdom. We are looking for a Manager of Critical Care for our Los Robles Regional Medical Center team where excellence ... to be an influencer in healthcare? **Apply for our Manager of Critical Care role today!** **Job...responsible and accountable for monitoring the delivery of patient care through the utilization of the nursing… more