- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team ... of UM coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will...performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will...performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare… more
- Bausch + Lomb (Los Angeles, CA)
- …Subject matter expert on Bausch + Lomb's patient support programs, payer utilization management , access issue resolution, financial assistance and Company ... the local and national payer landscape - this includes Specialty Pharmacy and Utilization Management criteria for assigned products. + Manage daily activities… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Enhanced Care Management (RN or LCSW) Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... Job Summary Reporting to the Director of Enhanced Care Management (ECM), the ECM Manager will be...years of leading a process, program or staff or supervisory/ management experience. Experience in Medi-Cal/Medicaid, Medicare , or… more
- LA Care Health Plan (Los Angeles, CA)
- …Collaborates with internal departments (Member Services, Provider Network Operations, Claims, Utilization Management , Pharmacy, and Quality Management ) to ... Manager , Customer Solution Center Appeals and Grievances Job...work collaboratively with multiple departments (Claims, Provider Network Operations, Utilization Management , Quality Management , Pharmacy)… more
- LA Care Health Plan (Los Angeles, CA)
- Product Solutions Manager III Job Category: Administrative, HR, Business Professionals Department: Medicare Product Location: Los Angeles, CA, US, 90017 Position ... safety net required to achieve that purpose. Job Summary The Product Solutions Manager III is responsible for assisting the product leadership team within the… more
- LA Care Health Plan (Los Angeles, CA)
- …for oversight and adequate performance of delegated activities. Collaborates with Utilization Management (UM), Provider Network Operations and Quality Dept.'s ... or health care with a focus in areas of Utilization Management claims. At least 3-5 years...Active, current and unrestricted California License Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM)… more
- Actalent (Los Angeles, CA)
- …industry leader in a fast-paced environment! Requirements: + CA RN license + Case Management experience + Medicare or Medical experience + Ability to work ... Care Organization is looking for a REMOTE RN Case Manager to join their growing team! Opportunity to make...management systems Skills: Case Management , Care Management , CA RN License, EMR System, Medicare ,… more
- LA Care Health Plan (Los Angeles, CA)
- …operational/functional areas. Responsible for scheduling, cost tracking/budget, resource management allocation and utilization , project component integration ... Portfolio Delivery Project Manager III Job Category: Information Technology Department: Enterprise... III Job Category: Information Technology Department: Enterprise Portfolio Management Office Location: Los Angeles, CA, US, 90017 Position… more
- LA Care Health Plan (Los Angeles, CA)
- …Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary 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
- LA Care Health Plan (Los Angeles, CA)
- …are generally complex and large in scope. In this capacity, the Program Manager will work collaboratively with leadership, management and other stakeholders ... Enterprise Shared Services Program Manager II (Limited Duration- 12 months)) Job Category:...issues for resolution. Accountable for scheduling, cost tracking/budget, resource management allocation and utilization , program component integration… more
- LA Care Health Plan (Los Angeles, CA)
- …departments throughout LAC including but not limited to QI, Pharmacy, Care Management , Utilization Management , Risk Adjustment, Products, Customer Solution ... Clinical Quality Program Manager II (CAHPS) Job Category: Clinical Department: Quality...guiding projects relating to quality excellence in Centers for Medicare and Medicaid Services (CMS) Five-Star Rating System and… more
- Elevance Health (Woodland Hills, CA)
- …information regarding case and determines appropriate area to refer or assign case ( utilization management , case management , QI, Med Review). + Conducts ... BCC authorizations, and/or deferrals. + Responsibilities exclude conducting any utilization management review activities that require the interpretation… more
- LA Care Health Plan (Los Angeles, CA)
- …acuities or care needs and requiring the highest clinical skills and judgement. Management of the caseload assigned by Manager includes: coordinating health care ... Care Management Specialist II Job Category: Clinical Department: Care...health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health… more
- LA Care Health Plan (Los Angeles, CA)
- …staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an ... Supervisor, Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time… 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 ... training programs and making presentations. Preferred: 2 years of Medi-Cal, Medicare or commercial product compliance. Regulatory change management and… more
- Elevance Health (Los Angeles, CA)
- …a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid ... who will be responsible for appeals reviews within our Medicaid and Medicare programs.** The **Behavioral Health Medical Director** is responsible for the… more
- UCLA Health (Los Angeles, CA)
- …closely with interdisciplinary stakeholders across the health system in finance, utilization management , operations, population health, data analytics, nursing, ... Care (MD SC) will be responsible for leading the management and day-to-day oversight of the Senior Care clinics,...Care clinics and will partner with an administrative clinic manager to oversee clinical workflows in the clinics. The… more