- Sharp HealthCare (San Diego, CA)
- …Professional (AHA BLS Healthcare) - American Heart Association; California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral Sciences; California ... employer business practices. **What You Will Do** Perform admission and concurrent review of patients, based upon needs regardless of payor sources. Identifies… more
- Sharp HealthCare (San Diego, CA)
- …patient care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/ utilization review demands to ... clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes. **Required Qualifications**... case management experience + 3 Years recent case management, utilization review , care… more
- Sharp HealthCare (San Diego, CA)
- …and internal transfer requests and direct admission requests. This position supports utilization review functions to ensure appropriate patient status and ... compliance with all local, state and federal regulations governing utilization review activities and/or care management. Expected...Bachelor's Degree in a health-related field. + 3 Years Utilization Management or case management within a… more
- Sharp HealthCare (San Diego, CA)
- …Management (ICM) team the Per Diem RN (Adv CN)-Unit A4 position supports utilization review functions to ensure appropriate patient status before the patient ... compliance with all local, state and federal regulations governing utilization review activities and/or care management. Expected...in Healthcare or a related field + 3 Years Utilization Management or case management within a… more
- Molina Healthcare (San Diego, CA)
- …to a 3 day/12 hour shift from then on._** **_Previous experience with Emergency Room Utilization Management / Utilization Review is preferred for this role. ... **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_PERMANENT SHIFT WILL BE :_** **_12...all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence… more
- Sharp HealthCare (San Diego, CA)
- …patient care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/ utilization review demands to ... of care. The position creates a balance between individual clinical needs with the efficient and cost-effective utilization...provides information to the department head as indicated. + Utilization review and utilization managementThe… more
- Sharp HealthCare (San Diego, CA)
- …care or clinical experience in area of specialty. + 2 Years Utilization / Case Management experience, preferably in a Managed Care setting. + California ... skills in area of expertise. + Proficient knowledge and understanding of utilization management, case management, healthcare finances, alternative care options,… more
- Scripps Health (San Diego, CA)
- …a lead or supervisory role. * Minimum of 2 years' experience in case management/ utilization review , discharge planning, and Millman/InterQual criteria usage. ... Diego's coastal North County, offering a full range of clinical and surgical services. We are proud to be...invite you to join our Scripps Memorial Hospital Encinitas Case Management team as a Supervisor of Case… more
- Rady Children's Hospital San Diego (San Diego, CA)
- … utilization of computers PREFERRED QUALIFICATIONS: Four years of experience Utilization review , case management, discharge planning experience Bilingual ... JOB SUMMARY: Case Managers function as liaisons between patients, their...and timely health care service. Their focus includes providing clinical documentation to third party payers to facilitate authorization… more
- Sharp HealthCare (San Diego, CA)
- …response to therapeutic interventions via collateral calls, conjoint therapy sessions, utilization review process, and/or referrals and revises care plan ... Day **FTE** 1 **Shift Start Time** **Shift End Time** California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral Sciences; AHA Basic Life… more
- Sharp HealthCare (San Diego, CA)
- … reviewers. + Participates in risk management reviews. + Assists in pharmacy utilization management, catastrophic case review , outreach programs, HEDIS ... selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations for updating current polices to meet… more
- Sharp HealthCare (San Diego, CA)
- …analyzing, interpreting and presenting clinical quality-related data. + Previous case review experience. **Preferred Qualifications** + Master's Degree In ... (eg RCA findings, mortality reviews, code blue reviews).Coordinates the case review process, including performing case...through utilization of independent judgment, training and clinical experience in analysis of case reviews,… more
- Magellan Health Services (San Diego, CA)
- …treatment. Continues physician oversight of at-risk patients deemed appropriate for complex case management and timely completion of all utilization management ... in CA. Part Time position. This position supports the clinical vision for the health plan(s) for all lines...case management plans. + Develops and implements a Utilization Management program and action plan, which includes strategies… more
- Sharp HealthCare (San Diego, CA)
- …leadership team members, ICM System Support Services and ICM System Centralized Utilization Review to ensure standardization of practice with a focus ... of financial competency.Partners with the Manager, Inpatient Care Management and Centralized Utilization Review leaders to manage and optimize patient throughput… more
- US Marine Corps (Oceanside, CA)
- …of the notations, and that continuity of client care is reflected in the case recording. Ensures that clinical staff members complete all requirements for ... NF-0180-04 or Social Worker, NF-0185-04. Incumbent serves as the as the Clinical supervisor for the Substance Abuse Counseling Center (SACC), Substance Abuse Program… more
- Sharp HealthCare (San Diego, CA)
- …response to therapeutic interventions via collateral calls, conjoint therapy sessions, utilization review process, and/or referrals and revises care plan ... with the interdisciplinary treatment team, coordinates patient care and provides case management for assigned patient under clinical supervision. **Required… more
- Sharp HealthCare (La Mesa, CA)
- …Meeting, case management.Performs drug therapy management duties as a clinical pharmacist as directed.Performs applicable clinical pharmacy consults on ... high-risk patients, the Discharge/TOC pharmacist also provides full discharge medication review and counseling. The position will manage populations of patients who… more
- Sharp HealthCare (San Diego, CA)
- …response to therapeutic interventions via collateral calls, conjoint therapy sessions, utilization review process, and/or referrals and revises care plan ... with the interdisciplinary treatment team, coordinates patient care and provides case management for assigned patient under clinical supervision. **Required… more
- Sharp HealthCare (San Diego, CA)
- …response to therapeutic interventions via collateral calls, conjoint therapy sessions, utilization review process, and/or referrals and revises care plan ... position is responsible for conducting behavioral health psychosocial assessments and clinical interventions, inclusive of individual, group, and family therapy in… more
- Scripps Health (San Diego, CA)
- …of utilization management including experience managing prior-authorization and concurrent review . * Knowledge of Medicare and Commercial health plans. * 3 years ... plus years clinical experience * 1-2 years inpatient acute hospital case management experience*OR*experience in either acute or non-acute case management.… more