- Ventura County (Ventura, CA)
- …awarded by CDPH. + Develops and presents therapeutic class review for medical staff review to include utilization , financial analysis, contract ... medical and pharmacy literature; communicate clearly and effectively; review and verify medication orders accurately and timely through electronic health… more
- The County of Los Angeles (Los Angeles, CA)
- …for personnel, facilities and equipment for the Occupational Therapy Department to the Medical Director and Hospital Administrator. + Confers with the hospital ... goals, objectives, and standards for the effective and efficient utilization of fiscal, material and personnel resources within the...Medical Director , Chiefs of Surgical, … more
- AECOM (San Francisco, CA)
- …in order to be able to identify support personnel and facilitate the quality review process for any regional project. In the event quality issues are identified, ... and implementation of solutions with the support of the Director of Project Delivery. + Ability to mentor junior...major pursuits by actively participating in the development and review of Project Plans and incorporation of other project… more
- Elevance Health (Los Angeles, CA)
- …+ May process a medical necessity denial determination made by a Medical Director . + Develops and fosters ongoing relationships with physicians, healthcare ... initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes....a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid… more
- Dignity Health (Bakersfield, CA)
- …**Position Summary:** The Manager, Network Strategy and Contracting reports to the Director of Provider Contracting. Key areas of oversight include negotiation of ... to senior leadership. - Analyzes network performance, including cost, quality, and utilization data to identify trends, opportunities, and areas for improvement. -… more
- CommonSpirit Health (Rancho Cordova, CA)
- …quality assurance reviews of work performed and communicating with department manager and director the outcomes of the review and any identified issues or ... not limited to: hospital administration, nursing leadership or their designee, medical staff, physicians and transportation vendors to ensure patients are assigned… more
- Providence (Napa, CA)
- **Description** Social Worker MSW in Utilization Review Unit at Queen of the Valley Medical Center, CA. This position is Full time and will work 8-hour Day ... Shifts. **Providence Queen of the Valley Medical Center** Providence Queen of the Valley ...**Job Shift:** Day **Career Track:** Clinical Professional **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas… more
- Sutter Health (San Francisco, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
- Elevance Health (Costa Mesa, CA)
- …nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy ... not in line with diagnosis. + Provide consultation to Medical Director on particularly peculiar or complex...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- City and County of San Francisco (San Francisco, CA)
- …employees in performing professional activities in Equal Employment Opportunity, including the review and evaluation of the work of DHR EEO or department EEO ... one or more major program areas. + Conduct and supervise the review , investigation, and resolution of discrimination complaints using mediation and investigation… more