- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Specialist, you will be responsible for: + Managing service requests and potential quality ... to all stakeholders. + Working closely with medical director, utilization management and quality review team to ensure that all cases are handled… more
- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Nurse, you will be responsible for: + Ensuring appropriate, cost-effective, and high- ... quality care for New Century Health Plan members + Conducting utilization management (UM) activities in accordance with health plan policies and regulatory… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... more at UCLA Health. You will play a key part in promoting high- quality , cost-effective medical care by applying clinical acumen and applicable policies and… more
- LA Care Health Plan (Los Angeles, CA)
- …Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM. Knowledge of Department of Health Care Services ... Utilization Management Admissions Liaison RN II...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. Under the direction of the Utilization Management , Assistant Manager, you will play a key role in processing and ... vital role within a leading health organization. Help ensure smooth and efficient case management processes to support quality care. Take your expertise to the… more
- Molina Healthcare (Long Beach, CA)
- …hour shift from then on._** **_Previous experience with Emergency Room Utilization Management / Utilization Review is preferred for this role. Experience ... **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_PERMANENT SHIFT WILL BE :_** **_12...or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current… more
- Providence (Santa Monica, CA)
- …and other relevant professionals that measurably improve performance. + Create, and analyze utilization review metrics, maintained in the form of a dashboard, ... data, and collaborates with other health care professionals and departments including Risk Management & Quality Management . Identifies trended problems and… more
- Teledyne (El Segundo, CA)
- …of regulatory agencies and applicable industry standards; and that the company Quality Management System (QMS) Policies, Procedures, and Work Instructions are ... systems and ground-based applications to facilitate efficient data access, management , and utilization for both civil and...customer / PO Regulatory PMA issues. + Perform contract review for quality provisions as part of… more
- Atlas (Whittier, CA)
- …and Senior Leadership. + Develop, through collaboration with ATO Practice Teams, a Quality Management System for the Practice. Collect, analyze, and implement ... the project, and with a heart-led approach that puts quality and safety at the center of everything we...office throughout the United States. **Duties and Responsibilities:** Ensure utilization in the **Construction Management Practice** meets… more
- ManTech (El Segundo, CA)
- …products, application of modern quality principles and methods including: quality management system standards, product and process controls, measurement and ... be performed during launch vehicle certification periods. + Draft and submit hardware review and quality engineering products which include but are not limited… more
- Medtronic (Los Angeles, CA)
- … new and modified product design documentation for quality characteristics, including manufacturability, serviceability, testability, reliability, and product ... documentation & traceability, engineering test methods and test result review . The candidate is expected to understand design transfer...Design / Supplier quality , & Post Market Quality functions, including but limited to: risk management… more
- Prime Healthcare (Inglewood, CA)
- …Provides leadership and supervision to case managers, social workers, case management coordinators/discharge planners, utilization review coordinators and ... continuous quality improvement tools. Responsible for the quality and resource management of all patients...to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
- Molina Healthcare (Long Beach, CA)
- … management , Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk ... adjustment, disease management , and evidence-based guidelines. + Experience in Utilization / Quality Program management + HMO/Managed care experience… more
- Medtronic (Los Angeles, CA)
- …(eg, plans, requirements, specifications, tests, test results, traceability, risk management documents, reports) meet Medtronic's quality , reliability, and ... product development teams like R&D, Ops, Design / Supplier quality , risk management etc. to ensure work...review boards and leads change control evaluations. Coordinate's quality decisions between different quality and engineering… more
- LA Care Health Plan (Los Angeles, CA)
- …health care resource utilization . Assures appropriate staff support of Utilization Management and other relevant committees. Supports the maintenance of ... (DMHC) regulations, applicable state and federal regulations, National Committee on Quality Assurance (NCQA) CM Certification, Management Services Agreements &… more
- Providence (Orange, CA)
- **Description** **THE ROLE** The position reports to the Regional Chief Quality Officer (CQO) Southern California with dotted line reporting to ministry Chief ... Medical Officer (CMO). The Executive Director Quality will provide strategic clinical leadership and form a strong linkage between ministry clinical and operational… more
- Elevance Health (Cerritos, CA)
- …2 years acute care clinical experience is required. **Preferred Qualifications** + Previous utilization review / utilization management experience in a ... with clinical reviewers and/or medical directors to ensure medically appropriate, high quality , cost effective care throughout the medical management process. +… more
- UCLA Health (Los Angeles, CA)
- …Care at Home Program, Population Health Pharmacy Programs, and Population Health Quality Management Program. The Assistant Director will lead and oversee ... that the priority initiatives are supported and meet the needs established quality and utilization improvement accountable care goals. Salary Range:… more
- Amity Foundation (Los Angeles, CA)
- …with contract provisions. * Work with network of CBPs to establish ongoing quality assurance monitoring processes and reviews. * Review Program monitoring tool ... Job Summary: The Quality Assurance (QA) Specialist for Third Party Administrator...Advocates to establish contracts with CBPs and optimize the utilization of CFCI and non-CFCI funds and comply with… 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 ... the work of staff, and evaluating employee performance. For this examination, Utilization Review is defined as provides technical and administrative direction… more