- Alameda Health System (Oakland, CA)
- …each individual in the classification. Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. ... utilization reviews and determine program improvements. Develop and implement utilization review policies and procedures in accordance with industry… more
- Universal Health Services, Inc. (Temecula, CA)
- …Southwest Healthcare Regional office in Temecula, CA is seeking a Per-Diem RN Central Utilization Review Nurse who will be responsible for carrying out ... ensure correct payer source for hospitalization and communication. Ensures compliance of utilization review practices as required by payers, external regulatory… more
- Santa Clara Family Health Plan (San Jose, CA)
- …and regulations. (D) Knowledge of Milliman/MCG guidelines or other nationally accredited utilization review criteria or standards. (D) Ability to consistently ... Utilization Management Review Nurse LVN Salary Range: $74,557 - $111,835 The expected pay range is based on many factors, such as experience, education, and the… more
- Alameda Health System (San Leandro, CA)
- …Follows AHS (Alameda Health System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of acute inpatient services. ... fields in EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review , membership in a professional organization.… more
- Santa Clara Family Health Plan (San Jose, CA)
- Supervisor, Utilization Management (Clinical) Salary Range: $111,168 - $172,310 The expected pay range is based on many factors, such as experience, education, and ... change. FLSA Status: Exempt Department: Health Services Reports To: Manager, Utilization Management GENERAL DESCRIPTION OF POSITION The Supervisor of Utilization… more
- Universal Health Services, Inc. (Temecula, CA)
- …seeking a Full-Time Utilization Coordinator who will supports the Centralized Utilization Review department and collaborates with staff across the Southern ... accesses Medi-Cal portal to submit required documents. Retrieves and delivers messages from Utilization Review Dept phone review line at least 4 times per… more
- San Francisco Health Plan (San Francisco, CA)
- Reporting to the Sr Medical Director, the Nurse Manager, Quality Review provides leadership and oversight of SFHP's quality review functions, ensuring timely and ... ensuring appropriate resolution strategies and compliance with regulatory standards. Review and approve medical necessity determinations for member reimbursement… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... other interdisciplinary team members; arranges followup care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all… more
- Center for Elders' Independence (Oakland, CA)
- …schedule changes and time off. Communicate schedule to Director of Transportation. Review and approve timecards of all Dispatchers daily in ADP. Collaborate with ... on daily requests from the Center Staff. Manage alert screen to log and review trips and drivers performance. Document and report any unusual incidents with drivers… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... provide requested clinical and psychosocial information to assurereimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively… more
