- CenterWell (San Diego, CA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … 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 ... eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/Manager/ Director / Medical Director to research any issues (ie… more
- Cedars-Sinai (Beverly Hills, CA)
- …You Will be Doing** The Case Management Coordinator provides support to the utilization review process. The coordinator works collaboratively with all team ... eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/Manager/ Director / Medical Director to research any issues (ie… more
- LA Care Health Plan (Los Angeles, CA)
- …to the Supervisor of ECM and receives clinical supervision as needed from the Medical Director of Care Management. The position is responsible for providing ... and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required… more
- 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 ... dose and duration edits, quantity limits, step-care edits, generic sampling medical policy review and development, member facing outreach initiatives… more
- Dignity Health (Bakersfield, CA)
- …of defined levels of hierarchy and composition of compliant denial notices to review medical records, authorize requested services and prepare cases for ... physician review based on medical necessity. The position...needed to make a determination and/or coordinate with the Medical Director as needed. - Ensure compliance… more
- Dignity Health (Bakersfield, CA)
- …of defined levels of hierarchy and composition of compliant denial notices to review medical records, authorize requested services and prepare cases for ... physician review based on medical necessity. The position...needed to make a determination and/or coordinate with the Medical Director as needed. - Responsible to… more
- Fresenius Medical Center (San Bernardino, CA)
- …Manager to oversee the facility's Home Therapies Program. * Maintains integrity of medical and operations records and complies with all data collections and auditing ... activities. *Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. *Manages clinic financials including… more
- LA Care Health Plan (Los Angeles, CA)
- …information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time ... Authorization Technician II (12 Month Assignment) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full… more
- Fujifilm (Sacramento, CA)
- …courses, and grant requests received by Fujifilm from industry societies, Academic Medical Centers, and other health-related organizations in the West and South ... improve how we report on various activities. The role reports to the Director , Marketing & Communication in the Endoscopy division. **Company Overview** At FUJIFILM… more