- 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
- LA Care Health Plan (Los Angeles, CA)
- …Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management (CM). Knowledge of Department ... Utilization Management Nurse Specialist RN II...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and… more
- Prime Healthcare (Ontario, CA)
- … Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according to ... or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan +… more
- Prime Healthcare (Chino, CA)
- …EDUCATION, EXPERIENCE, TRAINING Required qualifications. 1. Knowledge in discharge planning/ utilization management /case management terminology and functions, ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/177329/discharge-planner-ii utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityChino Valley Medical Center… 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
- Prime Healthcare (Montclair, CA)
- …Responsibilities Responsible for the quality and resource management ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/181372/case-manager-%28rn%29 utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityMontclair Hospital Medical Center… more
- Providence (Burbank, CA)
- …Associate's Degree in Health care or related field + 1 year of experience in utilization management or case management with experience in medical terminology ... of the Manager, this position is responsible for the distribution , review , accurate and timely processing of patient referrals requested from Facey providers.… more
- Molina Healthcare (Los Angeles, 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
- 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
- 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
- HCA Healthcare (Riverside, CA)
- …will need:** + Registered Nurse (RN) with current California license required, Case Management Certification or utilization review preferred + Associate's ... you passionate about delivering patient-centered care?** Submit your application for Case Management Coordinator position and spend more time at the bedside with the… 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