- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Oncology, 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
- Sutter Health (Emeryville, CA)
- …and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Some awareness ... meeting the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA will develop expertise on matters… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), … more
- Sharp HealthCare (San Diego, CA)
- …in-patient Care Management program that includes initial and concurrent review ; case management/discharge planning activities. Responsible for operational planning ... of the manager of in-patient care management and the Director of Utilization Management. **Required Qualifications** + 3 Years Experience in the acute patient… more
- Genesis Healthcare (Elk Grove, CA)
- …help older adults stay active and thrive while providing essential therapy for children at home and in school. With over 38 years of trusted service, our reach spans ... nursing centers, assisted and independent living facilities, outpatient clinics, and home -based care. We're proud to deliver personalized care exactly where and… more
- Sevita (Roseville, CA)
- …well lived. **$68,640.00** **Program Management - Program Director IDD Services Host Home ** Are you an experienced QIDP professional with management ability and the ... energy and focus to run a thriving Host Home program? As Program Director, you will be responsible...and property; assure security and accuracy; audit, monitor, and review individual's financial accounts + Implement proactive strategies to… more
- Dignity Health (Bakersfield, CA)
- **Responsibilities** This position is work from home ** **within California** **.** Please note: Rotating holidays and weekends will be expected as part of the ... regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the adverse determination… more
- Cedars-Sinai (Beverly Hills, CA)
- **Job Description** The Case Management Coordinator provides support to the utilization review process. The coordinator works collaboratively with all team ... Processes Extensions and Denial Letters, when needed. + Prepares Utilization Review Reports as needed. + Assists...+ Reviews hospital admissions information and enter/update inpatient, SNF, home health and DME referrals as needed. + Prints… more
- Ventura County (Ventura, CA)
- …of Santa Barbara. The County includes 42 miles of coastline which is home to the fol-lowing cities and points of interest: Camarillo, Fillmore, Moorpark, Ojai, ... life are among the many reasons our residents choose to call Ventura County " home ." The County of Ventura employs nearly 10,000 staff members who serve Ventura… more
- Evolent (Sacramento, CA)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more