- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- Dignity Health (Rancho Cordova, CA)
- …years Utilization experience required in health plan/UM operations, Acute or subacute utilization review . - Graduate of an accredited school of nursing. - BS ... a working knowledge of Utilization Management Working knowledge of the Utilization Management review processes, and regulatory requirements. Must have the… more
- Evolent (Sacramento, CA)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... cases. you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- HCA Healthcare (Riverside, CA)
- …a data-driven environment of quality and cost improvement, and develops systems to review utilization of resources and objectively measure outcomes of care in ... support for appeals and denials process, discharge planning, case management, and utilization review /management + You will consult with facility-level staff… more
- Rising Medical Solutions (Los Angeles, CA)
- …specialties: industrial rehabilitation nursing, medical case management, occupational health, orthopedics, home health care, utilization review , or quality ... assurance + Familiarity with regional physicians + CCM, and COHN-S/CM are optional but highly valued + Ability to drive to appointments within a 2-hour radius + Active, unencumbered registered nursing license with a minimum of 5 years' experience Benefits +… more
- Humana (Sacramento, CA)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more