- Prime Healthcare (Montclair, CA)
- …Maintains and coordinates Medicaid state submission forms for presentation to on-site reviewer and files them accordingly or as per facility's procedure. Assists ... EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions, in both… more
- Prime Healthcare (Chino, CA)
- …Center is nationally recognized, locally preferred, and community focused. Responsibilities The Utilization review tech essentially works to coordinate the ... utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls,… more
- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/236088/rn-case-manager utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service… 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
- Amergis (Santa Rosa, CA)
- …continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Minimum ... Requirements: + Current RN licensure in state practicing + At least one year of Case Management experience preferred + Current CPR if applicable + TB questionnaire, PPD or chest x-ray if applicable + Current Health certificate (per contract or state… more
- WelbeHealth (Los Angeles, CA)
- …we provide timely, quality, compliant, and cost-effective care to our participants. The Utilization Management LVN is accountable for the review and audit of ... ** Utilization Management LVN** At WelbeHealth, we are transforming...participants' charts with authorizations in the UM system + Review prior authorization requests for medical necessity and alignment… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive… more
- Amergis (Santa Rosa, CA)
- …+ Master's degree in Social Work from a school of social work accredited by the Council on Social Work Education required + Active license as an LCSW in state of ... The Licensed Clinical Social Worker collaborates with the multi-disciplinary team to provide input in the development of the plan of care for those patients/clients requiring social work intervention. The Licensed Clinical Social Worker provides counseling and… more
- CenterWell (Sacramento, CA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- Sharp HealthCare (San Diego, CA)
- …roundsReviews every patient under assigned workload initially and reviews based on review of care plan.Makes rounds and sees every patient identified per ... departmental guidelines during hospital stay beginning with the admission review of the case manager and reviews with the...quality of care issues encountered in the course of review .Serves as a resource for staff (as needed), and… more