- Prime Healthcare (Inglewood, CA)
- …status, ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case ... of staff and systems to effectively operate a comprehensive Case Management Program. The Director ...supervision to case managers, social workers and case management coordinators/discharge planners, utilization … more
- LA Care Health Plan (Los Angeles, CA)
- …of varied RN clinical experience in an acute hospital setting. At least 2 years of Utilization Management / Case Management experience in a hospital or HMO ... Utilization Management Nurse Specialist RN II...Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims… more
- Providence (Mission Hills, CA)
- …Answers and screens phones. Schedules and coordinates all meetings attended by Administrative Director of Managed Care, Contract Manager, Case Managers and UM ... ID:** 403694 **Company:** Providence Jobs **Job Category:** Health Information Management **Job Function:** Revenue Cycle **Job Schedule:** Full time **Job… more
- University of Southern California (Los Angeles, CA)
- …populations. The RN case manager role integrates the functions of utilization management , quality management , discharge planning assessment, and ... Participates in InterQual competency testing as requested by department director . + Outcomes Management * Participates in...Qualifications: + Pref Bachelor's degree + Pref 1 year Case management or utilization review… more
- University of Southern California (Alhambra, CA)
- … of specific patient populations. The role integrates the functions of complex case management , utilization management , quality management ... as requested by department director or Medical Director . + Outcomes Management 1. Participates in...5 years Clinical experience + Req 2 years Ambulatory case management or utilization review… 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 ... appropriateness of the level of care. For this examination, Case Management is a collaborative process that...vacancy in Department of Health Services, Harbor-UCLA Medical Center, Utilization Management Division. May also be used… more
- University of Southern California (Arcadia, CA)
- …timely and accurate information to payers. The role integrates and coordinates utilization management , care facilitation, and discharge planning functions. The ... follows up to resolve problems with payers as needed. + Completes utilization management for assigned patients. + Coordinates/facilitates patient cares… more
- Elevance Health (Los Angeles, CA)
- **Clinical Operations Medical Director ** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual** : This role enables associates to work virtually ... domains, including radiology, cardiology and oncology._ The **Clinical Operations Medical Director ** is responsible for supporting the medical management staff… more
- Molina Healthcare (Los Angeles, CA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Elevance Health (Los Angeles, CA)
- …Capabilities and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience. ... **Behavioral Health Medical** ** Director -Psychiatrist** **Appeals** **Location:** This role enables associates to...aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers… more
- UCLA Health (Los Angeles, CA)
- …of experience working managed care + Knowledge of Medicare Advantage experience with utilization management , quality improvement, or case management ... + Contribute to interdisciplinary care team rounds for complex case management . The UCLA Health salary range...required + Minimum of 2 years of experience in Utilization Management + 2 or more years… more
- Elevance Health (Los Angeles, CA)
- **Clinical Operations Associate Medical Director ** **Carelon Medical Benefits Management ** **Post Acute Care Benefit Utilization Management ** ... of care for the people we serve._ The **Clinical Operations Associate Medical Director ** is responsible for supporting the medical management staff ensuring… more
- University of Southern California (Los Angeles, CA)
- …budget preparation, expense monitoring, productivity monitoring, payor mix, FTE tracking/ utilization , revenue tracking, and billing integrity. Works with Clinical ... related to data analysis, process improvement, and strategic/operational project management , and will work closely with managers, directors, clinicians, quality… more
- Bayer (Pasadena, CA)
- …to make a real difference, there's only one choice.** **Cardiorenal Associate Director Regional Marketing - California** **PURPOSE** As part of the field-based ... incumbent will be responsible for activities across five key areas, in each case , acting as a champion to deliver brand communication strategy. 1. Strategic Thought… more
- Cedars-Sinai (Beverly Hills, CA)
- …to the TPL carrier of all injured worker cases receiving case management services. + Ensures appropriate utilization of medical services within the ... The Case Manager is responsible for the case management of patient while hospitalized and...date of discharge. + Communicates regularly with CSMPN Medical Director , Employee Health Services, Risk Management , and… more
- University of Southern California (Arcadia, CA)
- …AND CORE RESPONSIBILITIES * Accountable to the unit Manager and/or the Director of the department.* Adherence to identified nursing standards of practice.* Annually ... and patient care interactions.* Performs other duties as assigned by Manager / Director / Clinical Lead RN.* Prioritizes cases to provide service to most urgent… more
- LA Care Health Plan (Los Angeles, CA)
- …information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory ... Authorization Technician II (ALD) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA,...dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all… more
- UCLA Health (Los Angeles, CA)
- …The Home Health ICM Coordinator plays a key role in supporting our Utilization Management team to ensure safe, high-quality, and cost-effective care for ... patients enrolled in UCLA Medicare Advantage and Intensive Case Management programs. Under the supervision of the RN Assistant Director , you will coordinate… more
- UCLA Health (Los Angeles, CA)
- …or health care experience or knowledge of maternal child health agencies. + Case management / utilization management , health education and/or discharge ... Description Under general supervision of the Program Director (PD) at the UCLA Area Service Center...CL will offer some administrative support and will maintain case management activities for non-positive NBS results… more
- UCLA Health (Los Angeles, CA)
- …and work with clinicians, families and other state agencies for patient care. + Case management / utilization management , health education and/or discharge ... Description Under the general supervision of the Program Director at the UCLA Area Service Center (ASC),...Excel, PowerPoint, Outlook, etc.) and experience in charting or case management . + Ability to fly/travel to… more