- Prime Healthcare (Ontario, CA)
- …Healthcare is actively seeking new members to join our corporate team! Responsibilities The Utilization review lead essentially works to coordinate the ... for co-workers. UR lead will work closely with the Corporate/Facility Utilization review teams, Business Office, Case Managers, Physicians and administration… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print...so may result in an incomplete application and may lead to disqualification. We will send notifications to the ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually… more
- Elevance Health (Los Angeles, CA)
- ** Utilization Management Representative II** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... 7:00 AM and 5:00 PM Pacific. The **Behavioral Health (BH) Utilization Management Representative II** is responsible for coordinating precertification and prior… more
- Elevance Health (Los Angeles, CA)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... unless an accommodation is granted as required by law. The ** Utilization Management Representative I** is responsible for coordinating cases for precertification… more
- Elevance Health (Los Angeles, CA)
- **Genetic Counselor Review Associate** **Genetic Testing Utilization Review ** **Carelon Medical Benefits Management** **Virtual** : This role enables ... domains, including radiology, cardiology and oncology._ The **Genetic Counselor Review Associate** is responsible for authorization requests and determining their… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is...clinical unit. This position is responsible for the quality review of complex and/or escalated clinical A&G cases for… more
- The Walt Disney Company (Glendale, CA)
- …entertainment content, across all media platforms. **Job Summary:** We are hiring a Lead Engineer to establish and guide our AI Operations and Tooling practice, ... to accelerate operational stability and performance. As a hands-on technical lead , you will mentor engineers, design operational enablement frameworks, and partner… more
- Cedars-Sinai (Pasadena, CA)
- **Job Description** The Lead Patient Service Representative functions as an administrative team lead for the office. This position supports the physician and ... front office workflow. This position also assists with providing a review of Patient Service Representative administrative skills, assessing the workflow of… more
- TAD PGS, Inc. (Canoga Park, CA)
- We have an outstanding Contract to Hire position for aL5 Lead / L6 Scientistto join a leading Company located in theCanoga Park, CAsurrounding area. Pay Rate: $82.00 ... and maintain a Secret Security Clearance.** Shall have the capability to lead the analysis, design, and optimization of turbomachinery for liquid rocket engine… more
- Stantec (Paramount, CA)
- …on our performance. You will partner with our other Business Center (BC) Leaders to lead and manage, inspire and engage, and win and do work - building a culturally ... This role also collaborates with other BC Leaders to lead our behavioral safety culture, maintain quality and technical...and drive revenue. - Establish an effective Go/No Go Review process with Principals and track compliance. - Partner… more
- RxBenefits (Los Angeles, CA)
- …of changing variables, reporting needs, communication styles, and marketing agreements. + Lead multiple small teams with RxBenefits BDEs and Financial Analysts to ... schedules, channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer… more
- Elevance Health (Los Angeles, CA)
- …Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners ... information presented meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review of exception… more
- University of Southern California (Arcadia, CA)
- …outside referring physicians andmedical groups.* Communicates with insurance company utilization review and authorization personnel.* Gathers and maintains ... interactions.* Performs other duties as assigned by Manager / Director / Clinical Lead RN.* Prioritizes cases to provide service to most urgent case.* Organizes… more
- Stantec (Los Angeles, CA)
- Grounded in safety, quality, and ethics, our experts lead their fields and guide our work with rigor, a creative spirit, and vision for growth. We draw from more ... range of market sectors that leads to an expected 60% direct utilization - Primary point-of-contact for planning-related pursuits, inputs to operational and business… 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
- Elevance Health (Los Angeles, 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
- Cedars-Sinai (Los Angeles, CA)
- …technologies, artificial intelligence, and patient-centered care, the department continues to lead in advancing the science and practice of modern radiology. ... performance and quality improvement, risk management, and efficient resource utilization , all linked to evidence-based medicine. They will attract, mentor,… more
- AON (Los Angeles, CA)
- …client service for assigned book of business including billing, policy collection, review and transmittal in accordance with established service standards. + Liaise ... recognize when more information is needed to make a decision. + Drive utilization of available technology, portals and resources. + Demonstrate ability with all… more
- University of Southern California (Alhambra, CA)
- …+ Req 5 years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the last three years + Req Ability to work ... The role integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of… more
- WSP USA (Los Angeles, CA)
- …in accordance with all acceptable engineering practices. + Perform engineering review of permit applications, engineering design plans and specifications, standby ... practice and standards. + May serve as project manager and technical lead for PA&E/PS&E projects. + Responsible for subject matter expertise, innovation and… more