- 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
- 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
- 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)
- …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
- 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 ... in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska,...**Job Shift:** Day **Career Track:** Clinical Professional **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas… more
- 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 ... + Highland General Hospital + SYS Care Coordination + Full Time - Varies + Management + Req #:40791-30126...the collection, analysis and presentation data relevant to the utilization of healthcare resources, including but not limited to… more
- Sutter Health (Emeryville, CA)
- …clinical oversight and direction for critical health plan functions-including utilization management, credentialing, authorizations, concurrent review , and ... and quality measurement (HEDIS, CMS Stars). + Experience managing utilization management, credentialing, authorization processes, and concurrent review … more
- 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 ... Organization (Dignity Health MSO) is to build a system-wide integrated physician -centric, full -service management service organization structure. We offer a… more
- Dignity Health (Bakersfield, CA)
- …Organization (Dignity Health MSO) is to build a system-wide integrated physician -centric, full -service management service organization structure. We offer a ... of Provider Contracting. Key areas of oversight include negotiation of physician and ancillary provider agreements, oversee the implementation of all contracts… more