- Elevance Health (Woodland Hills, CA)
- …to Medicaid plans in partnership with blue cross blue shield plans. The Medical Director is responsible for the administration of physical and/or behavioral ... of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. **This position… more
- Insight Global (Irvine, CA)
- Job Description Under the general direction of the Director of UM , UM Manager, and the UM Supervisor, the Prior Authorization LVN ensures that prior ... accordance with the policies and procedures approved by the physician group Medical Directors and UM Committees. * 7 Audits and evaluates patient medical … more
- LA Care Health Plan (Los Angeles, CA)
- …the needs of LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists UM Educator/Manager/ Director ... that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations...Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical , Dental and Vision + Wellness Program + Volunteer… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM /Prior Authorization. Skills Required: Demonstrated proficiency in Medical Terminology ... Job Summary The Authorization Technician II supports the Utilization Management ( UM ) Specialist by handling all administrative and technical functions of the… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Documents in platform/system of record. Utilizes designated software ... hospital or HMO setting. Preferred: Managed Care experience performing UM and CM at a medical group...experience performing UM and CM at a medical group or management services organization. Experience with Managed… more
- LA Care Health Plan (Los Angeles, CA)
- …required to achieve that purpose. Job Summary Under the general direction of the Director of Utilization Management ( UM ) the Program Manager II is responsible ... leading and managing a portfolio of strategic and transformational UM programs and projects that are generally complex and...Expected to serve as a strategic thought partner with director and senior management leadership team members to advise… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Documents in platform/system of record. Utilizes designated software ... or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group...experience performing UM and CM at a medical group or management services organization. Experience with Managed… more
- LA Care Health Plan (Los Angeles, CA)
- …to the Supervisor of ECM and receives clinical supervision as needed from the Medical Director of Care Management. The position is responsible for providing ... internal LA Care departments such as Care Management (CM), Utilization Management ( UM ), Managed Long Term Services and Support (MLTSS), Social Services, Behavioral… more
- LA Care Health Plan (Los Angeles, CA)
- …the Regulatory Compliance unit, the Advisor also advises and supports the Manager, Director , and Chief Compliance Officer on other duties as assigned to support the ... and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management ( UM ) and so forth) and developing audit tools. Demonstrated experience… more