- 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 ... benefits with a remote work option. JOB SUMMARY: The Medical Director , UM is a...UM is a clinical subject-matter expert for the Utilization Management Team and shall assist in the oversight… more
- Dignity Health (Rancho Cordova, CA)
- …review a referral. Fosters the relationship between the Pre-Authorization team and the Medical Director and Physician Reviewers. - Tracks cost savings from ... home.** **Position Summary:** Under the guidance and supervision of the department Manager/ Director the Supervisor of Utilization Management is responsible and… more
- Evolent (Sacramento, CA)
- …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet...patient care + **Minimum one year of experience with Utilization Review ( UM ) in a managed care… more
- Humana (Sacramento, CA)
- …**Reporting Relationship:** This position reports directly to the Behavior Health Lead Medical Director . **Requirements:** . BCBA-D with Florida licensure or ... medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work assignments involve moderately… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
- LA Care Health Plan (Los Angeles, CA)
- …safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations ... Supervisor, Utilization Management RN Job Category: Clinical Department: ...LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists … more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Document in platform/system of record. Utilize designated software ... Utilization Management Nurse Specialist RN II Job Category:...or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons...logs and other sources. + Achieves and maintains benchmarked utilization and cost management ( UM ) goals and… more
- Sharp HealthCare (San Diego, CA)
- …for medical necessity are issued under the direction of the Medical Director or designee.Assists with transfers, when necessary. + Demonstrates knowledge ... or services, readmissions to acute or visit to the Emergency Department.Informs Director , QI/ UM of any quality issues.Attends hospitalists rounds, as required,… more
- Evolent (Sacramento, CA)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... developing cardiovascular programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** + Process… more
- Provider Solutions & Development (Burbank, CA)
- Providence St. Joseph Medical Center is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in ... You will work closely with the physician leadership, the Director of Care Management, and executive leadership; in particular...* Ability to effectively communicate with, motivate, and assist medical staff leadership to adhere to utilization … more
- CVS Health (Sacramento, CA)
- …timely and consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance ... resides in Pacific or Mountain Time Zone. In the Medical Director role you will provide oversight...including post-graduate direct patient care experience. **Preferred Qualifications:** Previous UM experience with a Health Plan / Payor. Board… more
- CVS Health (Sacramento, CA)
- …System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management) experience *Active and current state medical license without ... have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical… more
- Sutter Health (Burlingame, CA)
- …work closely with the medical staff, including house staff, and all utilization management ( UM ) personnel, Care Management (CM) personnel to develop and ... develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices,… more
- Alameda Health System (Oakland, CA)
- … information and reports to appropriate committees and in conjunction with the Director of Care Management identifies utilization issues affecting the quality of ... at Highland is responsible for the day-to-day operations of facility-wide utilization , discharge planning and care coordination. **DUTIES & ESSENTIAL JOB… more
- Cedars-Sinai (Torrance, CA)
- …specific to the department(s) below: **Department Duties and Responsibilities** ** Utilization Management** Maintain compliant UM processes that are ... **Job Description** **Job Summary: Key Job Responsibilities** The Executive Director is responsible for overseeing and providing strategic direction and vision to… more
- Magellan Health Services (San Diego, CA)
- …relationships at all levels within HAI-CA. Interact with HAI-CA CMC Chief Clinical Officer, Medical Director and Associate Medical Director , Physician ... customer's site. Including, but not limited to, Network, QI, UM , and DVOD meetings. + Track agenda and follow... data; under the direction of the supervisor or Medical Director , assists with discharge planning and… more
- Dignity Health (Rancho Cordova, CA)
- …educational training and assessments for orientation of new staff in Utilization Management ( UM )/Continuing Care (CC). Additionally, conducts, coordinates, and ... from home.** **Position Summary:** Under the direction of the Director for Continuing Care, the Registered Nurse (RN) is...vision goals and specified service lines of Dignity Health Medical Foundation. - Improve job knowledge, enhances skills, and… more
- LA Care Health Plan (Los Angeles, CA)
- …health care auditing and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management ( UM ) and so forth) and developing audit ... unit, the Advisor also advises and supports the Manager, Director , and Chief Compliance Officer on other duties as...Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical , Dental and Vision + Wellness Program + Volunteer… more