- Sutter Health (Sacramento, CA)
- …joining Sutter Health! **Organization:** SHSO-Sutter Health System Office-Valley **Position Overview:** The Physician Advisor (PA) is a key member of the ... to appropriately optimize the use of Sutter Health Internal Physician Advisor Services (IPAS). The physician...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- The County of Los Angeles (Los Angeles, CA)
- …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...by subordinate supervisors on number and status of reviews, physician advisor referrals, and type of … more
- Alameda Health System (Oakland, CA)
- …placement (eg, inpatient, observation, outpatient). 3. Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may ... System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day +… more
- LA Care Health Plan (Los Angeles, CA)
- …and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and ... Utilization Management Nurse Specialist RN II Job Category:...cases and reports are maintained and referred to the Physician Advisor /UM Director. Document in platform/system of… more
- Provider Solutions & Development (Burbank, CA)
- Providence St. Joseph Medical Center is seeking a Physician Advisor /UM Medical Director to join a strong leadership team promoting high-value care in Burbank, ... of medical group management experience required * Must have working knowledge of utilization management and review essential to operations management and to… more
- Sharp HealthCare (San Diego, CA)
- …pre-admission review , utilization management, and concurrent and retrospective review Process. Performs and mentor's physician training of A&G and UM ... selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations for updating current polices to meet… more
- Alameda Health System (San Leandro, CA)
- …necessarily performed by each individual in the classification. 1. Coordinates all utilization review functions, including response to payor requests for ... guidelines; refers questionable cases to the CM Manager or physician advisor for determination. 3. Takes appropriate...experience in Case Management in an acute setting or utilization review at a medical group or… more
- Sharp HealthCare (La Mesa, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... Care Management and provides information to the department head as indicated. + Utilization review and utilization managementThe RN CM will:Conduct initial… more
- Alameda Health System (San Leandro, CA)
- …action when cases do not meet criteria - coordinates denials with the attending physician , and the UR physician advisor . Prepares case reports; documents ... preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or… more
- Elevance Health (Costa Mesa, CA)
- …management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisor 's on the development of care management treatment plans. + ... providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires a BA/BS… more
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