• Utilization Management

    LA Care Health Plan (Los Angeles, CA)
    Utilization Management Quality Reporting and Auditing Specialist I Job Category: Clinical Department: Utilization Management Location: Los ... required to achieve that purpose. Job Summary The Utilization Management (UM) Quality Reporting and Auditing Specialist I is responsible for dynamically… more
    LA Care Health Plan (11/05/25)
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  • Supervisor, Utilization Management

    LA Care Health Plan (Los Angeles, CA)
    Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for… more
    LA Care Health Plan (10/14/25)
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  • Analyst, Risk & Quality Reporting

    Molina Healthcare (San Diego, CA)
    **JOB DESCRIPTION** **Job Summary** The Analyst, Risk and Quality Reporting role supports Molina's Risk and Quality Health Plan team. This position designs ... on how to use reports + Build intervention strategy reporting for the Risk and Quality interventions...with data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics + Familiarity with… more
    Molina Healthcare (09/25/25)
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  • Senior Medical Management Nurse - VCHCP

    Ventura County (Ventura, CA)
    …of the following: + Certified in Case Management , CCM. + Experience with Utilization Management and/or Quality Assurance in a Managed Health Care Plan. ... direction, the Senior Medical Management Nurse is responsible for performing utilization review, case management , and quality improvement functions to… more
    Ventura County (11/07/25)
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  • Senior Specialist | PI - Quality /Safety…

    Sharp HealthCare (Chula Vista, CA)
    …in Healthcare Quality (CPHQ) - National Association for Healthcare Quality ; Certified Professional in Healthcare Risk Management (CPHRM) - American ... Quality -PREFERRED + Certified Professional in Healthcare Risk Management (CPHRM) - American Hospital Association -PREFERRED + Certified Professional in… more
    Sharp HealthCare (11/08/25)
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  • Director, Inpatient System Care Management

    Alameda Health System (Oakland, CA)
    …denials management , and non-reimbursed services, promoting effective resource utilization , clinical documentation/queries, quality care and patient safety; ... patient experience reporting ; in conjunction with the Quality Leadership, identifies utilization issues affecting the...+ Required Experience: Seven to ten years of case management or quality experience in addition to… more
    Alameda Health System (11/07/25)
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  • Director, Quality Engineering - WW IPD

    BD (Becton, Dickinson and Company) (Brea, CA)
    …applicable industry and regulatory standards and meet customer expectations for safety and effectiveness. Reporting to the VP, Quality Management WW IPD & ... applicable industry and regulatory standards and meet customer expectations for safety and effectiveness. Reporting to the VP, Quality Management WW IPD &… more
    BD (Becton, Dickinson and Company) (08/28/25)
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  • Director, Accounting Lease and Asset…

    Ross Stores, Inc. (Dublin, CA)
    …contracts, identifies embedded leases and applies proper accounting treatment for management utilization in decision making process\. * Drive cross\-functional ... and methodology\. * Analyze and interpret of the financial results for management 's utilization in business decision\-making processes\. Responsible for monthly… more
    Ross Stores, Inc. (09/25/25)
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  • Medical Director - Sharp Health Plan - Hybrid…

    Sharp HealthCare (San Diego, CA)
    …and provides professional leadership and direction to the utilization /cost management and clinical quality management functions. Works collaboratively ... Medical Management + Department ( Utilization /Cost Management and Quality Management ) +...in risk management , pharmacy utilization management , catastrophic case review, outreach programs, HEDIS reporting more
    Sharp HealthCare (11/12/25)
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  • Director of Clinical Services, Faculty Practice…

    UCLA Health (Los Angeles, CA)
    …+ Ensure seamless integration of various clinical functions with Utilization Management , such as Case Management , Quality Improvement, Credentialing, and ... programs and medical services with an emphasis on optimizing Utilization Management for the Faculty Practice Group... Management for the Faculty Practice Group (FPG) Management Services Organization (MSO). Reporting to Chief… more
    UCLA Health (09/20/25)
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