- Sutter Health (San Francisco, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of ... care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely… more
- LA Care Health Plan (Los Angeles, CA)
- …and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The ... include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to assist… more
- Genesis Healthcare (Willows, CA)
- …Clinical Operations Area Director in the timely completion of the annual merit review for therapy staff. 7. Assists Clinical Operations Area Director in the hiring ... 8. Participates in and coordinates the timely completion of the annual merit review for therapy staff. 9. Assumes responsibility for hiring therapy staff (in… more
- Elevance Health (Walnut Creek, CA)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in ... and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens and… more
- Rubrik (Palo Alto, CA)
- …global Professional Services financial goals, including top-line revenue targets, utilization rates, and overall profitability across all assigned territories. ... on key performance indicators (KPIs) and global operating metrics (eg, utilization , CSAT, time-to-value, time to deploy). + **Strategic Partner Ecosystem:**… more
- Dignity Health (Los Angeles, CA)
- …90 days of hire. + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute… more
- Dignity Health (Northridge, CA)
- …effectively. + Technical Skills: Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Customer Service: A commitment to ... and presentation skills to effectively collaborate with diverse stakeholders. + Utilization Management & Case Management: Understanding of how utilization … more
- Sutter Health (Berkeley, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Working ... working with multidisciplinary treatment team. The position coordinates the utilization management, resource management, discharge planning, post-acute care referrals… more
- University of Southern California (Arcadia, CA)
- …outside referring physicians andmedical groups.* Communicates with insurance company utilization review and authorization personnel.* Gathers and maintains ... physician in complex cases with multiple practitioners.* Ensures appropriate resource utilization relevant to the financial, regulatory and clinical aspects of… more
- Dignity Health (Oxnard, CA)
- …AHA BLS card **Skills** + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ... will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute… more