- 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 guidelines +… more
- LA Care Health Plan (Los Angeles, CA)
- … Management Admissions Liaison RN II (After Hours Evening) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM. Knowledge of Department of Health Care Services… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... Nursing Experience Required: At least 5 years of varied clinical experience in an acute hospital setting. At least...Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management … 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 ... Health. You will play a key part in promoting high- quality , cost-effective medical care by applying clinical ...promoting high- quality , cost-effective medical care by applying clinical acumen and applicable policies and guidelines in the… 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 ... and much more. Learn more at providence.jobs/benefits. **About the Team** Providence Clinical Network (PCN) is a service line within Providence serving patients… more
- UCLA Health (Los Angeles, CA)
- …Advantage team, you will be responsible for assisting with the day-to-day management of the UM department and coordinators. This will involve coordinating staff ... and key performance indicators. You will hire and train non- clinical coordinator staff as well as manage and monitor...as well as manage and monitor their production and quality performance. This position involves researching and resolving simple… more
- LA Care Health Plan (Los Angeles, CA)
- Clinical Quality Program Manager III Job...LAC including but not limited to QI, Pharmacy, Care Management , Utilization Management , Risk Adjustment, ... net required to achieve that purpose. Job Summary The Clinical Quality Program Manager is responsible for...Rating Systems (QRS). The position is responsible for strategizing quality improvement programs and ongoing management using… more
- UCLA Health (Los Angeles, CA)
- …risk and be held accountable for value-based outcomes. The Assistant Director of Clinical Quality Performance will collaborate with Office of Population Health ... Accountable Care (OPHAC) leadership to develop, execute, and oversee Population Health's Clinical Quality Performance function. The role will be responsible for… more
- Elevance Health (Cerritos, CA)
- …of applicable clinical criteria and relevant Carelon Medical Benefits Management policies pertaining to utilization review. + Demonstrate and maintain ... Carelon Medical Benefits Management is currently seeking a Board-Certified Surgeon (or...subspecialties beyond general surgery) to participate in pre-authorization and quality improvement solutions for a wide range of surgical… more
- Select Medical (Los Angeles, CA)
- …allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and ... part of the discharge planning process. The primary job functions in Case Management include: Clinical Interventions/Discharge and Care Planning Management ;… more
- Cedars-Sinai (Culver City, CA)
- …as liaison, for administrative support activities including facilities management , pharmacy, utilization management , quality management , risk ... Award 19 years in a row for providing the highest- quality medical care in Los Angeles. We were also...guidelines. 7. Works in a collaborative role with the management team, staff and physicians in the clinical… more
- Cedars-Sinai (Marina Del Rey, CA)
- … management team to ensure optimal clinical operations with a lens on clinical quality and patient safety, and the efficient and effective functioning of ... fiscal structure, including patient assignment, risk and specialty network structures, and utilization management . Functions as key resource for staff and… more
- The County of Los Angeles (Los Angeles, CA)
- CLINICAL NURSING DIRECTOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/3136407) Apply CLINICAL NURSING DIRECTOR I Salary $152,555.76 ... PLAN (MAPP) : This position is subject to the provisions of the Management Appraisal of Performance Plan (MAPP). Initial salary placement and subsequent salary… more
- Cedars-Sinai (Los Angeles, CA)
- …the delivery of patient care and ensures optimal levels and continuous improvement of clinical and service quality within the unit for all service line ... heart muscle function and heart valve dysfunction. As the Manager, of Clinical Operations for the Cardiovascular Intervention Center, you will ensure daily… more
- LA Care Health Plan (Los Angeles, CA)
- …Skills Required: Knowledge of state, federal and regulatory requirements in Appeals/Care/Case/ Utilization Management / Quality . Strong verbal and written ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical ...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and… more
- ThermoFisher Scientific (Long Beach, CA)
- …approved business writing standards. + Escalates observed deficiencies and issues to clinical management expeditiously and follow all issues through to ... clinical research portfolio, our work spans laboratory, digital and decentralized clinical trial services. Your determination to deliver quality and accuracy… more
- Cedars-Sinai (Beverly Hills, CA)
- …responsible for clinical programs designed to make clinical quality , safety, or efficiency improvements. (preferred) **Educational/Licensure/Certifications ... we strive for. **What will you be doing:** The Clinical Value Program Leader (CVPL) is responsible for supporting...performance - all while maintaining or improving the overall quality of care delivered. + Leads implementation of departmental… more
- UCLA Health (Los Angeles, CA)
- …experience; or equivalent of education and experience in case management , utilization management or prior clinical documentation review experience, ... assisting with appropriate documentation strategies. Partnering with Medical Coding, Case Management and the Quality team, you will gather/analyze information… more
- Cedars-Sinai (Los Angeles, CA)
- …Coordinates administrative support activities including facilities management , patient billing, utilization management , quality management , and risk ... people every single day? Are you passionate about providing outstanding and high- quality service to patients and their family members?** **Join our world-class… more