- 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
- Dignity Health (Bakersfield, CA)
- …to review medical records, authorize requested services and prepare cases for physician review based on medical necessity. The position partners with both ... as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the adverse… more
- Dignity Health (Bakersfield, CA)
- …of Provider Contracting. Key areas of oversight include negotiation of physician and ancillary provider agreements, oversee the implementation of all contracts ... to senior leadership. - Analyzes network performance, including cost, quality, and utilization data to identify trends, opportunities, and areas for improvement. -… 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
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... to physician instruction. May schedule patient appointments.In partnership with physician , may review pre-printed teaching materials or written instructions… more
- 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
- Stanford Health Care (Palo Alto, CA)
- …Ideal Candidate: Experience: At least 3 years in a surgical specialty as a Physician Assistant (PA) or Nurse Practitioner (NP), with a preference for at least 1 ... Provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth… more
- Dignity Health (Bakersfield, CA)
- …to review medical records, authorize requested services and prepare cases for physician review based on medical necessity. The position partners with both ... as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the adverse… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... problem and routes to physicians. Returns phone calls according to physician instruction. May schedule patient appointments.In partnership with physician ,… more
- Sharp HealthCare (La Mesa, CA)
- …required within 90 days of hire. **Essential Functions** + Verification and review of medication ordersReviews all medication orders for appropriate dose, duration, ... protocols and consultation with the interdisciplinary team.-Completion of a daily profile review for each patient consisting of the following elements:* Age, sex,… more