- Prime Healthcare (Inglewood, CA)
- …education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200257/ director -of- case - management utilization - ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities We are seeking a strategic and compassionate Director of Case Management to… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …team of physicians and nurses working with the Rady Children's Health Network. The Utilization Management Medical Director will collaborate closely with the ... with a remote work option. JOB SUMMARY: The Medical Director , UM is a clinical subject-matter expert for the...furnishing guidance in areas of clinical quality, practice patterns, utilization management , case management… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan +… more
- Stanford Health Care (Palo Alto, CA)
- …- 5+ years of experience as an RN - 3+ years of experience in case management / utilization review Why work at Stanford Medicine | Stanford Health ... Facilities, Durable Medical Equipment vendors) in collaboration with Contract Management and Legal Affairs. + Assists Director ...Abilities** + Knowledge of principles and best practices of case management , utilization review, social… more
- LA Care Health Plan (Los Angeles, CA)
- …of work/licensure. The Supervisor is a subject matter expert (SME) in Care/ Case / Utilization Management and supporting regulations, policies, protocols, and ... of 7 years of acute/clinical care experience. Minimum of 2 years of experience in Case /Care/ Utilization Management in an acute care or health plan setting.… more
- LA Care Health Plan (Los Angeles, CA)
- …of varied 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
- Sharp HealthCare (San Diego, CA)
- …hospitalists rounds, as required, to discuss high risk patients requiring case management follow up.Attends clinical in-services or required operational/clinical ... utilizing designated computer systems.Complies with contracted health plan requirements for case management activities performed in a manner consistent with… more
- Sharp HealthCare (La Mesa, CA)
- …performance planning, competency and individual development planning process.Maintain current knowledge of case management , utilization management , and ... outcomes. **Required Qualifications** + 3 Years Recent acute care nursing experience or case management experience. + California Registered Nurse (RN) - CA Board… more
- Alameda Health System (Oakland, CA)
- …classification. + Accountable for Patient Care Coordination activities including system-wide Case Management , Care Coordination and Discharge Planning. + Aligns ... Director , Inpatient System Care Management + Oakland, CA +... Case Management with AHS strategic and operational objectives. + Optimizes efficient care … more
- Sharp HealthCare (San Diego, CA)
- …+ Participates in risk management reviews. + Assists in pharmacy utilization management , catastrophic case review, outreach programs, HEDIS reporting, ... findings in conjunction with the Quality Improvement Director . + Assists in POS/PPO Case Management and high-cost review with CMO and Claims management … more
- Humana (Sacramento, CA)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Providence (Napa, CA)
- **Description** Under minimal supervision and at the direction of the Case Management Director , the Inpatient Social Worker/Patient Counselor is responsible ... Per-Diem **Job Shift:** Day **Career Track:** Clinical Professional **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work Location:**… more
- Sharp HealthCare (San Diego, CA)
- …in Nursing or related health care degree. + 3 Years recent clinical nursing or case management experience. + California Registered Nurse (RN) - CA Board of ... minimum of two professional goals each year. (Goals to be determined by case manager and director ).Promotes self-awareness and knowledge of current medical… more
- Stanford Health Care (Palo Alto, CA)
- …Knowledge, Skills and Abilities** + Knowledge of principles and best practices of case management , utilization review, social work, care coordination and ... employee evaluations, and program development for the Department of Social Work and Case Management . Additionally, this position serves as a resource for problem… more
- Humana (Sacramento, CA)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Humana (Sacramento, CA)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… 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
- Genesis Healthcare (Carmichael, CA)
- …of the rehabilitation department, including oversight related to case management , quality improvement, care planning, clinical utilization , and patient ... The Director of Rehab is responsible for the efficient management of rehabilitation services in their assigned account(s). This position also assists… more
- Genesis Healthcare (Elk Grove, CA)
- …of the rehab department, including oversight related to case management , quality improvement, care planning, clinical utilization , and patient identification ... Area Director ). 11. Assumes responsibility for daily staffing and utilization with input from treating therapists, consideration of clinical requirements, and… more
- Genesis Healthcare (American Canyon, CA)
- …of the rehab department, including oversight related to case management , quality improvement, care planning, clinical utilization , and patient identification ... for hiring therapy staff (in conjunction with the Clinical Operations Area Director ). Assumes responsibility for daily staffing and utilization with input… more