- Emanate Health (Covina, CA)
- …Education Requirement:** **Minimum Experience Requirement:** Minimum of three years of utilization management experience. Experience in quality - related job ... States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by… more
- Molina Healthcare (Long Beach, CA)
- …for overseeing delegated activities to ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), ... as necessary to comply with state, federal and National Committee for Quality Assurance (NCQA) guidelines, and other applicable requirements. * Distributes… more
- Molina Healthcare (Long Beach, CA)
- …and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), ... functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy… more