- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The … more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …mental health and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $35.00-44.19 Per Hour ... RN/LCSW/LMFT/LPCC $54.00-68.18 Per Hour REPORTS TO: Director of Utilization Review DESCRIPTION OF POSITION: Work as member of multi-disciplinary treatment team… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity ... protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices....support and review of medical claims and utilization practices. Complete medical necessity and level of care… more
- Centene Corporation (Sacramento, CA)
- …perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… more
- 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
- 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
- Elevance Health (Walnut Creek, CA)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the identification ... ** Utilization Management Representative I** **Location** : This role...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… 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
- 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
- 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