- Martin Luther King, Jr. Community Hospital (Los Angeles, CA)
- …information to payors. The role integrates and coordinates the functions of utilization management , care progression and care transition. The Case Manager ... other Federal or State regulatory agency requirements specific to Utilization Review and Discharge Planning. The Care...all reimbursement categories to determine medical necessity, assure high quality of care and efficient utilization of… more
- 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 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
- Elevance Health (Los Angeles, 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)
- …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 (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
- 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
- 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
- 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
- UCLA Fielding School of Public Health (Los Angeles, CA)
- …medicine/patient blood management , education of physicians regarding test utilization and interpretation, and active engagement in quality assurance ... Faculty Transfusion Medicine and Patient Blood Management Physician Apply now to Faculty Transfusion Medicine...Application Window Open date: May 23, 2024 Most recent review date: Thursday, Oct 31, 2024 at 11:59pm (Pacific… more
- Ryder System (Rancho Dominguez, CA)
- …the Management Trainee to work cross functionally across Operations, Asset Management , Sales, Quality , and Rental. **Essential Functions** + Responsible for ... _Job Seekers can review the Job Applicant Privacy Policy by clicking...the customer relationship activities by providing quality customer interface, proactive customer management , issue… more
- Elevance Health (Los Angeles, CA)
- …equivalent and a minimum of 3 years acute care clinical experience or case management , utilization management or managed care experience; or any combination ... with clinical reviewers and/or medical directors to ensure medically appropriate, high quality , cost effective care throughout the medical management process. +… more
- LA Care Health Plan (Los Angeles, CA)
- …nursing experience in direct patient care, such as ambulatory care, home care, or case management . OR experience in Utilization Review or Care Management ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...a case/care management environment. Preferred: Experience in utilization review , skilled nursing, home health, discharge… more
- LA Care Health Plan (Los Angeles, CA)
- …Perform utilization review of cases and participates in our care management programs periodically. Provide utilization review and call coverage on ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...with our operational systems and tools while also performing utilization review of cases. The Medical Director… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...purpose. Job Summary The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all… more
