- Humana (Sacramento, CA)
- …Degree or BSN degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + ... help us put health first** We are seeking a Senior Accreditation Professional who will work in...on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming … more
- Sharp HealthCare (San Diego, CA)
- …to accrediting and regulatory agency feedback. + Supports pre-admission review, utilization management , and concurrent and retrospective review Process. Performs ... risk management reviews. + Assists in pharmacy utilization management , catastrophic case review, outreach programs,...CMO CPTAC and Peer Review Committees. + Partners with Senior Management including CMO and COO to… more
- The Boeing Company (Sylmar, CA)
- …USA, ABET accreditation is the preferred, although not required, accreditation standard. ** Senior Level (Level 4)** Education/experience typically acquired ... Company** , is seeking broad range of levels to include **Experienced and Senior ** **Industrial Engineers** to join the space solar panel engineering team in… more
- Ventura County (Ventura, CA)
- …medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as ... a member of the Senior Management Team, in developing goals, plans...procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval… more
- Evolent (Sacramento, CA)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... , you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Elevance Health (Los Angeles, CA)
- …Senior Leadership Teams in the areas of medical provider relations, quality management , utilization management , clinical systems design, and clinical ... the state employed. **Preferred Skills, Capabilities and Experiences** + **Leadership & Utilization Management :** Prior leadership role in a managed care… more
- Evolent (Sacramento, CA)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more
- HCA Healthcare (Riverside, CA)
- …will assemble regional physician advisory panels to provide ongoing feedback to HCA senior management , and serves as a liaison between committees and ... review/ management + You will consult with facility-level staff regarding delegated utilization management and disease management operations under managed… more
- Evolent (Sacramento, CA)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... Director you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- The County of Los Angeles (Los Angeles, CA)
- …used to fill a vacancy in Department of Health Services, Harbor-UCLA Medical Center, Utilization Management Division. May also be used to fill other vacancies ... + Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT INFORMATION:… more
- San Jose State University (San Jose, CA)
- …and reporting, which contributes to meeting institutional, federal, and accreditation requirements. The position provides comprehensive data management , ... Services, Probationary, Full Time, Research Job Summary Reporting to the Senior Director of Institutional Research and Strategic Analytics, the Institutional… more
- Evolent (Sacramento, CA)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- The County of Los Angeles (Los Angeles, CA)
- …technical and support personnel providing technical and consultative services to the management of a program; or oversees a small Countywide health program. ... CLASSIFICATION STANDARDS: This is the senior -/supervisory-level class in the Health Program Analyst Series. Positions allocable to this class are located in the… more
- The County of Los Angeles (Los Angeles, CA)
- …medical, nursing, pharmaceutical, medical record, and social services, program management , diagnostic and treatment services. Essential Job Functions Audits and ... consultation services to contract providers, advising the providers on the utilization of treatment modalities. Writes reports of audits and negotiates a… 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 ... LA Care's risk to state/federal sanctions and fines- communicate required action to senior management /Board of Governor (BoG), Plan Partner staff. 2. Internal… more
- San Jose State University (San Jose, CA)
- …data products and services related to institutional priorities set forth by senior leadership and the strategic plan. The incumbent will conceptualize, design, ... initiatives related to student success to support institutional research, accreditation , academic planning, assessment, academic scheduling, and planning at the… more
- Qualcomm (San Diego, CA)
- …advancing Program Management best practices. + Liaise with technical leaders and senior management to optimize resource utilization across a large ... Serve as the focal point for program communications to Senior Management . + Compile regular program status...Tableau, PowerBI), Gantt charts, etc. + PMP or other accreditation is a plus. + Strong planning and organizations… more
- Sutter Health (Crescent City, CA)
- …of equipment, quality control of test systems, non-conforming event management , customer satisfaction, lab licensure/ accreditation and continual process ... obstetrics, diagnostic imaging, laboratory, rehabilitation, skilled nursing, psychiatric care, senior care, and home health services. About Crescent City: Moderate… more
- Sharp HealthCare (San Diego, CA)
- …risk for adverse health outcomes, and utilize condition-specific targeted interventions, disease management , case management or complex case management ... compliance, wellness, and other areas as appropriate or necessary optimal program management . With the Director, the Chief Medical Officer (CMO), Medical Directors… more