- Ventura County (Ventura, CA)
- …of quality, safety, and patient-centered care. The Quality Assurance (QA) and Utilization Review (UR) units ensure accurate and appropriate clinical ... Behavioral Health Quality Assurance Specialist Print...and Notices of Actions. This position continually collaborates with Utilization Review staff regarding chart/documentation reviews and… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- Sharp HealthCare (Chula Vista, CA)
- …**What You Will Do** The purpose of the Sr. Performance Improvement Specialist is to improve clinical outcomes including responsibilities relating to leading teams ... in the utilization of Change Acceleration Process and PI tools and...through measurement and analysis along with concurrent and retrospective review of performance information. Assists with operational planning and… more
- Dignity Health (San Bernardino, CA)
- …Rights, AB1203 and other Federal or State regulatory agency requirements specific to Utilization Review and Discharge Planning. The Case Manager partners with ... Known for its programs in maternity care and pediatrics behavioral health and long-term subacute care for adults and...elements of the case manager role include: Care Coordination, Utilization Review and Discharge Planning. This position… more
- LA Care Health Plan (Los Angeles, CA)
- …by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health ... Care Management Specialist II Job Category: Clinical Department: Care Management...the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and… more
- KBR (San Diego, CA)
- Title: Special Operations Cognitive Performance Specialist (Coronado, CA) THIS POSITION OFFERS RELOCATION. Belong. Connect. Grow. with KBR! KBR is a company of ... in individual and group settings, in specific cognitive, mental, behavioral , psychosocial, perceptual, learning, adaptive thinking, human engagements, and emotional… more
- Providence (Santa Rosa, CA)
- …Group setting highly desirable. **Essential Functions:** + Assists in physician performance/ behavioral deficiencies as requested0 + Assists in formal Peer Review ... + Effectively obtains, interprets, and analysis physician information and utilization data. + Communicate regularly with referring physician regarding service;… more
- US Marine Corps (Twentynine Palms, CA)
- …organization functioning smoothly and effectively. Responsibilities Serves as the Clinical Specialist within the Behavioral Health program, Community Counseling ... policies, conducts screenings, clinical counseling services and case management services for Behavioral Health Branch programs. Serves as the first point of contact… more
- Cedars-Sinai (Los Angeles, CA)
- …Medical Directors of the CSMN, CSMN primary care physician leadership, CSMN specialist physician leadership, and executive leadership within the CSMN, including but ... conditions and MH disorders. + Provides regularly scheduled caseload reviews to behavioral health specialists. Caseload reviews focus primarily on patients who are… more
- Highmark Health (Sacramento, CA)
- …network providers to support key clinical transformation programs with a focus on utilization of appropriate care. The team member works with internal and external ... is responsible for building relationships, engaging clinicians, educating on Utilization Management policies and processes, developing workflows and resources, and… more
- HCA Healthcare (San Jose, CA)
- …at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical ... for assuring the safe, effective, evidence-based, and cost-effective selection and utilization of medications for the patients in which their team serves.… more