• Utilization Review Tech II

    Prime Healthcare (Ontario, CA)
    …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... experience, education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209380/ utilization - review -tech-ii/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management … more
    Prime Healthcare (05/30/25)
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  • Utilization Review Tech II

    Prime Healthcare (Garden Grove, CA)
    …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with… more
    Prime Healthcare (05/08/25)
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  • Utilization Review Nurse

    Dignity Health (Carmichael, CA)
    **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The ** Utilization Review RN** is responsible for the ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the...to be successful in the role:** + Understand how utilization management and case management … more
    Dignity Health (06/01/25)
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  • Physician Advisor, Utilization…

    Sutter Health (Sacramento, CA)
    …resources, medical necessity, documentation best practices, level of care progression, denial management and compliance with governmental regulations and ... with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
    Sutter Health (05/31/25)
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  • Utilization Review Nurse Supervisor…

    The County of Los Angeles (Los Angeles, CA)
    …for the issuance of denial letters. + Reviews, retrospectively, utilization review records for completeness, use of appropriate codes, correctness ... UTILIZATION REVIEW NURSE SUPERVISOR I Print...Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that… more
    The County of Los Angeles (05/22/25)
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  • Pre-Service Utilization Management…

    Dignity Health (Bakersfield, CA)
    …as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the ... of defined levels of hierarchy and composition of compliant denial notices to review medical records, authorize...The position partners with both the Pre-Service and In-Patient Utilization Management teams. Ensures to monitor and… more
    Dignity Health (05/15/25)
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  • Director, Utilization Management

    Alameda Health System (Oakland, CA)
    Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
    Alameda Health System (05/06/25)
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  • Manager, Care Management

    Alameda Health System (Oakland, CA)
    …+ Performs daily clinical rounds and monthly audit of charts on care management activities ( utilization review , discharge planning and Interrater ... clinical consultant regarding care management issues; guides clinical staff with review of assessments and care plans, evaluates utilization reviews or… more
    Alameda Health System (05/06/25)
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  • Medical Director, Ventura County Health Care Plan

    Ventura County (Ventura, CA)
    …medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
    Ventura County (05/10/25)
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  • Regional Medical Director - SCMG Admin - Sharp…

    Sharp HealthCare (San Diego, CA)
    …Skills, and Abilities** + In-depth knowledge of medical care delivery systems, utilization management , quality assurance, peer review , contracting, benefits ... problem resolution of grievances. + Participates with systems integration of mutual utilization review and finance issues related to appropriate level and… more
    Sharp HealthCare (04/17/25)
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