- Prime Healthcare (Inglewood, CA)
- …education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/189094/ director -of- case - management utilization - ... Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Director of Case Management … more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan +… more
- HCA Healthcare (Riverside, CA)
- …**Introduction** Do you want to join an organization that invests in you as a Director Case Management ? At Riverside Community Hospital, you come first. HCA ... make a difference. We are looking for a dedicated Director Case Management like you...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all… more
- United Therapeutics (Sacramento, CA)
- …pulmonary diseases, and other orphan diseases. **How you'll contribute** The Associate Global PV Case Management Director plays a key role in management ... processing for commercial UT products, including PM GSD workflows; Maintain unified PM Case Management operating procedures and monitor systems to ensure all PM… more
- Stanford Health Care (Palo Alto, CA)
- …Knowledge, Skills and Abilities** + Knowledge of principles and best practices of case management , utilization review, social work, care coordination and ... leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by...program development for the Department of Social Work and Case Management . Additionally, this position serves as… more
- LA Care Health Plan (Los Angeles, CA)
- …of varied clinical experience in an acute hospital setting. At least 2 years of Utilization Management / Case Management experience in a hospital or HMO ... Utilization Management Nurse Specialist RN II...Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims… more
- Cedars-Sinai (Los Angeles, CA)
- …with internal and external stakeholders. + Promotes the role of Case management , medical social work & utilization management within the organization ... **Key Job Responsibilities** Provides overall strategic and operational leadership of the Case Management Department which encompasses the disciplines of Care… more
- Providence (Santa Monica, CA)
- **Description** **THE ROLE** The Director , Case Management promotes and supports the mission, vision and objectives of Saint John's Health Center and is ... responsible and accountable for the clinical, fiscal, and personnel management of Case Management on a 24 hour, 7 day basis. Develops and utilizes mechanisms… 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 (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
- Amergis (Palo Alto, CA)
- …Palo Alto, CA Start date: 2/3 Duration: 13 weeks, possible extensions Unit: Case Management Inpatient Shift: Days Hours: 4x10s, 40 hours/week Requirements: CA ... accessibility of services + Follows State/County mandated guidelines for the nurse case management programs + Participates in outreach activities to the… 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...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Sharp HealthCare (La Mesa, CA)
- …performance-planning, competency and individual development planning process.Maintain current knowledge of case management , utilization management , and ... Case Manager Certification; Accredited Case Manager (ACM) - American Case Management Association (ACMA); Bachelor's Degree in Nursing; Master's Degree… more
- Providence (Tarzana, CA)
- …in Healthcare related field (Acute, Ambulatory, Post-Acute, etc.) + 2 years' Experience in Case Management (Care Coordination or Utilization Management ) ... care coordination along a continuum through effective transitional care management and utilization managment. Recognizing the patient's...-by- case basis at each ministry by the Director of Care Management in consultation with… more
- Magellan Health Services (San Diego, CA)
- …physician oversight of at-risk patients deemed appropriate for complex case management and timely completion of all utilization management activities. ... Involvement in the development of case management plans. + Develops and implements a Utilization...(QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various… 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...size of region or line of business. The Medical Director conducts Utilization Management of… more
- The County of Los Angeles (Los Angeles, CA)
- …the following: + Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT ... appropriateness of the level of care. For this examination, Case Management is a collaborative process that...vacancy in Department of Health Services, Harbor-UCLA Medical Center, Utilization Management Division. May also be used… 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...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Cedars-Sinai (Los Angeles, CA)
- …and vetting of any community MH provider as needed. + Supports and advises Utilization Management , CS 360, and population health teams as needed, including ... other CSMN providers of Population Health services, the Medical Director of Pain Management , and Population Health...to track all assigned patients and prioritize patients for case review and treatment adjustment. + Recommends any treatment… more
- City and County of San Francisco (San Francisco, CA)
- … Director oversees key functions, including clinical operations, quality assurance, utilization management , the transition of Electronic Health Records (EHR), ... to Epic, CalAIM (eg, clinical documentation, LOE, PURQC), managed care plans, utilization management , BHS regulatory compliance, and contracted programs as part… more