- TEKsystems (Los Angeles, CA)
- …Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes. ... provider and member claims for accuracy and compliance + Review and process claims in accordance with UM guidelines...RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with HMO/Medicare claims,… more
- Deloitte (Los Angeles, CA)
- …clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist , utilization review , informatics RN, Quality, DRG ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk...financial concerns and other business controversy. A Clinical Documentation Specialist (CDS) works to ensure accuracy and completeness of… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Sharp HealthCare (San Diego, CA)
- …**What You Will Do** The purpose of the Sr. Performance Improvement Specialist is to improve clinical outcomes including responsibilities relating to leading teams ... in the utilization of Change Acceleration Process and PI tools and...through measurement and analysis along with concurrent and retrospective review of performance information. Assists with operational planning and… more
- University of Southern California (Los Angeles, CA)
- The Clinical Nurse Specialist serves as a resource/consultant for all departments regarding clinical specialty, conducts/ participates in research across varied ... initiatives. Integrate research and evidence based practice into the development, review and revision of patient education materials. Identifies and communicates… more
- Stanford Health Care (Palo Alto, CA)
- …a Stanford Health Care job.** **A Brief Overview** The Senior Value Based Management Specialist works as a key link between the supply chain and clinical teams. This ... used, all while maintaining or improving patient care quality. The specialist collaborates with physicians, clinical staff, and administrative leaders to standardize… more
- University of Southern California (Arcadia, CA)
- …Minimum of three years' experience in clinical disciplines (RN, MD, FMG) or utilization review /case management in an acute care facility, with clinical ... and other clinical staff. + Meets established productivity targets for record review and appropriate query placement. + Demonstrates working knowledge of ICD-10 CM… more
- Maersk (Los Angeles, CA)
- Logistics Specialist **Opportunity** As a company, we promote a culture of honesty and integrity, and value the trust it allows us to build with customers and ... excellence that will save time and money. The Control Tower Logistics Specialist will be responsible for providing the proactive feedback and recommendations on… more
- Alameda Health System (San Leandro, CA)
- …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... SLH Care Management Specialist + San Leandro, CA + San Leandro...in a health care field or one year in Utilization Management at a Medical Group or Health plan… more
- Oracle (Sacramento, CA)
- …Manager and the roles within the pods (eg, Business Analyst, Integration Specialist , QA, etc.) and contribute to strategic planning, direction, and goal setting ... procedures, contractual budgets, providing expert-level insight on the development, utilization , and revision of contractual agreements. + Maintains customer… more