- Alameda Health System (Oakland, CA)
- …Responsible for the coordination and support of the AHS Utilization Review Committee. + Responsible for overseeing patient, physician and staff satisfaction ... the collection, analysis and presentation data relevant to the utilization of healthcare resources, including but not limited to...Works closely with the VP of Care Management and Physician Advisors on any audits and secondary reviews; may… more
- Highmark Health (Sacramento, CA)
- …DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the multidisciplinary team ... Inc. **Job Description :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in… more
- Sharp HealthCare (San Diego, CA)
- …pre-admission review , utilization management, and concurrent and retrospective review Process. Performs and mentor's physician training of A&G and UM ... selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations for updating current polices to meet… more
- Ventura County (Ventura, CA)
- …+ Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + At ... providers. VCHCP also provided insurance coverage for employees of physician groups through the end of December 2022. Medical...care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review … more
- Sharp HealthCare (San Diego, CA)
- …selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations. + Participates in the retrospective ... responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management, and concurrent and retrospective rev1ew process.… 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
- Centene Corporation (Sacramento, CA)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... of care for each patient/family in collaboration with the physician , social worker and all members of the interdisciplinary...provides information to the department head as indicated. + Utilization review and utilization managementThe… 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
- 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 ... clinical review and decisions including but not limited to: physician and member appeals, member or provider information/education. + Participate on… more