- 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
- Humana (Sacramento, CA)
- …the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in a medical management review organization, ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- HCA Healthcare (Campbell, CA)
- …to ensure functions such as Claims System Configuration, Customer Service, Utilization Management and Compliance are executing their assigned accountabilities. This ... configuration audits as needed + Draft and prepare for review by the President of SCCIPA and CFO Letters...of Agreement as directed + Accountable for submitting monthly physician rosters to health plans based on Credentialing Committee… more
- Sutter Health (Roseville, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of ... the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager, Medical Social Worker and bedside RN to assure… more
- Sutter Health (Burlingame, CA)
- …and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of ... the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager, Medical Social Worker and bedside RN to assure… more
- Ventura County (Ventura, CA)
- …that establish, expand, and maintain the pool of eligible service providers. + Utilization review : + Uses professional skills in quality management activities ... of their journey. THE POSITION: Under direction of a physician or registered nurse, the Field Based Psychiatric Technician...such as utilization review , monitoring and evaluation procedures, and… more
- Sutter Health (Modesto, CA)
- …and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of ... the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager, Medical Social Worker and bedside RN to assure… more
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... disposition of Medi-Cal, self-pay, and out-of-plan patients, including working with physician to determine readiness for transfer, securing placement and completing… more