- Kepro (Anaheim, CA)
- Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job Summary As a Utilization Clinical Reviewer , you'll ... the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the California Mental Health...a pivotal role in upholding industry benchmarks. This full-time Clinical Reviewer Remote position based in the… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services...and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General… 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, or health ... more at UCLA Health. You will play a key part in promoting high-quality, cost-effective medical care by applying... in promoting high-quality, cost-effective medical care by applying clinical acumen and applicable policies and guidelines in the… more
- Elevance Health (Cerritos, CA)
- … criteria and relevant Carelon Medical Benefits Management policies pertaining to utilization review . + Demonstrate and maintain knowledge of applicable ICD-10, ... Ability to work in a dynamic, fast-paced environment + Preferred interest in Surgical utilization review + Strong analytical skills + Ability to multi-task +… more
- The County of Los Angeles (Los Angeles, CA)
- …NICU, Burn ICU), Oncology, Parenteral Nutrition, Ambulatory Care, Drug Utilization Review , Anti-Coagulation, Purchasing Consultant, Drug Information, ... CLINICAL PHARMACIST Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/1221716) Apply CLINICAL PHARMACIST Salary $164,533.20 - $188,433.84… more
- Select Medical (Los Angeles, CA)
- …+ Coordinates with other departments, ie: Pre-Admissions, Admissions, Patient Accounts, Utilization Review , PPS Coordinator, etc., to assure positive fiscal ... CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) **Pay Rate: $50 - $58.65 depends on experience** Case… more
- Elevance Health (Cerritos, CA)
- …Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services and ... imaging, cardiac testing and sleep management services. Medical Directors in Clinical Operations determine the medical necessity of outpatient radiology, cardiology,… more
- Cedars-Sinai (Beverly Hills, CA)
- …team, the home department, and other stakeholders to find opportunities to enhance clinical efficiency and appropriateness of care. As part of a ... across the Consortium. + Maintains close coordination between the home department and Clinical Efficiency & Value team to review outcomes of the programs,… more
- Guidehouse (Los Angeles, CA)
- …a way to ensure optimal efficiency in the patient Access operations. * Performs clinical review of all inpatients to determine medical acceptance following the ... years' experience in nursing or one-year related nursing experience in utilization review /insurance/case management/medical clearance. * Graduation from an… more
- The County of Los Angeles (Los Angeles, CA)
- …+ Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT INFORMATION: *In ... the work of staff, and evaluating employee performance. For this examination, Utilization Review is defined as provides technical and administrative direction… more
- Cedars-Sinai (Beverly Hills, CA)
- …services are accomplished in a timely and efficient manner. Additionally, providing clinical support and oversight for all utilization management (UM) activities ... applicable state and federal regulations, including CMS and/or Medicare Part D and Medi-Cal, as well as accreditation standards...as requested. + With the team, develops and implements clinical criteria for the review of non-formulary… more
- Dignity Health (Northridge, CA)
- …Federal or State regulations pertaining to their practice. + Have an understanding of Utilization Review to progress plan of care. + Understand how ... Dignity Health, one of the nation's five largest health care systems. We are part of a 21-state network of nearly 9,000 physicians, 62,000 employees and more than… more
- Elevance Health (Los Angeles, CA)
- …or regulation, must be in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... and implementing programs to improve quality, cost, and outcomes. + May provide clinical consultation and serve as clinical /strategic advisor to enhance … more
- Elevance Health (Los Angeles, CA)
- The **Manager II Behavioral Health Services** is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management (BH CM) or a ... Center** include: Managing a team of licensed clinicians and non- clinical support staff responsible for telephonic crisis intervention, substance… more
- Sevita (Alhambra, CA)
- …Program Supervisor and Mentor Recruiter evaluations in consultation with Area Director; review and approve annual Program Services Clinical Coordinator and other ... **Mentor Community Services** , a part of the Sevita family, provides community-based services...and property; assure security and accuracy; audit, monitor, and review individual's financial accounts + Implement proactive strategies to… more
- Prime Healthcare (Inglewood, CA)
- …and supervision to case managers, social workers, case management coordinators/discharge planners, utilization review coordinators and utilization review ... offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference....designed to facilitate and ensure the achievement of quality, clinical and cost effective outcomes and to perform a… more
- LA Care Health Plan (Los Angeles, CA)
- …by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health ... Care Management Specialist II Job Category: Clinical Department: Care Management Location: Los Angeles, CA,...Medi-Cal and Medicare regulations. Ability to work as a part of a diverse team and gain consensus and… more
- Fresenius Medical Center (Arleta, CA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering...kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture… more