- 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
- UCLA Health (Los Angeles, CA)
- …for assessing and coordinating care for a diverse group of patients. This in-patient utilization review case manager position will work on-site at our UCLA ... coordination of care. In this role you will perform utilization review while assuring the delivery of...License and BLS certification + Recent experience in case management , utilization management and discharge… more
- Prime Healthcare (Lynwood, CA)
- …Responsibilities Responsible for the quality and resource management ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/185693/case-manager utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySt. Francis Medical Center… 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
- 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
- Children's Hospital Los Angeles (Los Angeles, CA)
- …one of the following areas: Case Management ; use of Clinical pathways; or Quality / Utilization Management and/or Review . Ability to utilize managed ... care, utilization management , and discharge planning concepts. Computer Literacy. Well-developed written and verbal communication skills. Demonstrated… more
- Cedars-Sinai (Los Angeles, CA)
- …situations regarding reimbursement issues, social work, discharge planning, utilization review , continuity of care, and systems management . + Collaborates ... regarding reimbursement issues, social work, discharge planning, utilization review , continuity of care/readmission avoidance, and systems management . +… more
- LA Care Health Plan (Los Angeles, CA)
- …in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The expected pay range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
- Molina Healthcare (Los Angeles, CA)
- …or Interqual criteria **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of… more
- Elevance Health (Los Angeles, CA)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... **Preferred skills, qualifications and experiences:** + Prior experience in inpatient Utilization Management , preferred. + Knowledge and/or experience of MCO,… 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
- Fresenius Medical Center (Irwindale, CA)
- …to quality improvement. This includes promoting the adoption and utilization of Corporate Medical Advisory Board Recommended Algorithms and Standing Orders, ... quality improvement tools and electronic applications. + Performs desk review of facility Quality Assessment and Performance Improvement (QAPI) documentation… 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
- 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...compensation. Application Window Open date: May 23, 2024 Next review date: Wednesday, Jan 15, 2025 at 11:59pm (Pacific… 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 (D-SNP) Job Category: Clinical Department:...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)
- …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
- Elevance Health (Los Angeles, CA)
- …ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or call center ... that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or...plans strongly preferred. + BA/BS degree preferred. + Previous utilization and/or quality management and/or… more