- Prime Healthcare (Inglewood, CA)
- …status, ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case ... of staff and systems to effectively operate a comprehensive Case Management Program. The Director ...supervision to case managers, social workers and case management coordinators/discharge planners, utilization … more
- Sharp HealthCare (San Diego, CA)
- …Years experience as an LVN in a hospital or clinical setting. + 2 Years utilization / Case Management experience, preferably in a Managed Care setting. + ... hiring teams. **What You Will Do** To provide comprehensive utilization management and coordination of care for...Experience as a case manager or discharge planner interacting with managed care… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... and determinations within required turnaround times specific to the case type. Identifies requests needing medical director ...setting. Previous experience to have a strong understanding of Utilization Management / Case Management … more
- LA Care Health Plan (Los Angeles, CA)
- …of work/licensure. The Supervisor is a subject matter expert (SME) in Care/ Case / Utilization Management and supporting regulations, policies, protocols, and ... of 7 years of acute/clinical care experience. Minimum of 2 years of experience in Case /Care/ Utilization Management in an acute care or health plan setting.… more
- Elevance Health (Walnut Creek, CA)
- Utilization Management / Medical Management Nurse - CA (JR169412) **Virtual:** This role enables associates to work virtually full-time, with the exception ... critical thinking skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate… more
- Alameda Health System (Oakland, CA)
- …classification. + Accountable for Patient Care Coordination activities including system-wide Case Management , Care Coordination and Discharge Planning. + Aligns ... Director , Inpatient System Care Management + Oakland, CA +... Case Management with AHS strategic and operational objectives. + Optimizes efficient care … more
- Sharp HealthCare (La Mesa, CA)
- …performance planning, competency and individual development planning process.Maintain current knowledge of case management , utilization management , and ... outcomes. **Required Qualifications** + 3 Years Recent acute care nursing experience or case management experience. + California Registered Nurse (RN) - CA Board… more
- Sharp HealthCare (San Diego, CA)
- …+ Participates in risk management reviews. + Assists in pharmacy utilization management , catastrophic case review, outreach programs, HEDIS reporting, ... findings in conjunction with the Quality Improvement Director . + Assists in POS/PPO Case Management and high-cost review with CMO and Claims management … more
- Sharp HealthCare (San Diego, CA)
- …performance planning, competency and individual development planning process.Maintains current knowledge of case management , utilization management , and ... Vehicles; Accredited Case Manager (ACM) - American Case Management Association (ACMA); Master's Degree in...by the OON Department to insure that clinical and utilization management information is clearly and concisely… more
- Humana (Sacramento, CA)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of… more
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