- Sharp HealthCare (San Diego, CA)
- …appeals and grievances. **Required Qualifications** + 3 years' experience in claims, utilization review , appeals or member services in a managed care ... in Commercial regulatory and accreditation audits. Pulls case files, completes quality review of documents and data files, participates in audit interviews to… more
- Sharp HealthCare (San Diego, CA)
- …appeals and grievances. **Required Qualifications** + 3 years' experience in claims, utilization review , appeals or member services in a managed care ... Thorough understanding of health services and delivery models, including hospital, physician , ancillary, home health, prescription drugs, etc. Knowledge of various… more
- Stanford Health Care (Palo Alto, CA)
- …+ Translate and implement national initiatives at SHC. + Ability to work full -time. **Licenses and Certifications** + PA - Physician Assistant State Licensure ... least 3 years in a surgical specialty as a Physician Assistant (PA) or Nurse Practitioner (NP), with a...and adherence to policy through practice analysis and case review of APPs with physicians. + Investigate and respond… 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
- Ventura County (Ventura, CA)
- …that establish, expand, and maintain the pool of eligible service providers. + Utilization review : + Uses professional skills in quality management activities ... required to travel throughout Ventura County, CA Job Type Full -Time Regular Job Number 0343HCA-25AA (VM) Department Health Care...such as utilization review , monitoring and evaluation procedures, and… more
- The County of Los Angeles (Los Angeles, CA)
- …Salary $137,323.92 - $205,556.40 Annually Location Los Angeles County, CA Job Type Full time Job Number Y5121S Department HEALTH SERVICES Opening Date 09/07/2017 + ... health care of patients. The Nurse Practitioner is assigned full -time to this role and receives professional medical supervision...Incumbents seek the expert opinion or advice of a physician whenever the incumbent determines if a case falls… 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)
- …+ Employee Health Assistance Fund that offers free employee-only coverage to full -time and part-time colleagues based on income. Learn more about Employee Benefits ... to ensure functions such as Claims System Configuration, Customer Service, Utilization Management and Compliance are executing their assigned accountabilities. This… 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