Utilization Manager Jobs in Los Angeles

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Search Results - Utilization Manager Jobs in Los Angeles

Medical Director, Utilization Management — Lead Value Care

L.A. Care Health Plan-Los Angeles-appcast.io-5 days ago

A major health organization in Los Angeles is seeking a Medical Director for Utilization Management. This role requires significant clinical oversight, leadership experience, and collaboration across teams to ensure quality care and compliance...

Travel RN Case Manager

Prime Staffing-Los Angeles-today

Certifications: BLS – AHA Must-Have: Strong assessment, discharge planning, and utilization review skills /n Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with providers, social workers...

Medical Director, Utilization Management

L.A. Care Health Plan-Los Angeles-appcast.io-5 days ago

the safety net required to achieve that purpose. Job Summary The Medical Director, Utilization Management provides clinical oversight of authorization decision making and processing, pre and post payment claims review activities, payment integrity clinical...

Grievance Supervisor

The Alliance-Los Angeles-mindmatch.ai-today

Grievance work involves complex coordination, investigation and specific resolution within regulatory timeframes. Areas of Grievance work include: Appeals: A member complaint involving an adverse benefit determination by an Alliance Utilization Management...

Remote Behavioral Medical Director

Centene Corp.-Los Angeles-appcast.io-4 days ago

Utilization Management experience and knowledge of quality accreditation standards.* Actively practices medicine**Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing...

Product Manager, Authorization Services

Oscar Health-Los Angeles-mindmatch.ai-today

mission is to fundamentally redesign this experience. You will be part of the Authorization Services team, which is rethinking utilization management from a reactive approval process into a proactive, intelligent system that guides members to the right...

Medical Director (Part-Time)

Oklahoma Complete Health-Los Angeles-appcast.io-4 days ago

Qualifications for this role include:*** MD or DO without restrictions* Must be licensed in Mississippi* Board Certified Physician* Utilization Management experience and knowledge of quality accreditation standards highly preferred**Position Purpose:** Assist...

Registered Nurse (RN) – Case Manager - RNCM#5627

NavitasPartners-Los Angeles-talentnest.com-3 days ago

Position Overview "Navitas Healthcare, LLC" is an experienced Registered Nurse Case Manager to support care coordination, discharge planning, and utilization management in an acute care hospital setting. The RN Case Manager will work closely...

Part-Time Medical Director - Remote Quality Leader

Oklahoma Complete Health-Los Angeles-appcast.io-5 days ago

be a licensed MD or DO in Mississippi, board-certified, and have experience in Utilization Management. The position offers competitive pay ranging from $225,700 to $428,900 annually, along with a comprehensive benefits package including health insurance...

Clinical Review Nurse - Prior Authorization nv

Jobs-Los Angeles-jobvertise.com-1 week ago

information in health management systems to ensure compliance with regulatory guidelines Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members...

Case manager ii

Los Angeles-icims.com-1 month ago

efficient strategies which maximize quality care within the current health care environment for the identified patient population. The Case Manager II is responsible for the coordination of utilization management, discharge planning and other health care...

Medical Director, Behavioral Health

Molina Healthcare-Los Angeles-appcast.io-6 days ago

to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health...

Vice President of Medical Case Management

Ami Network-Los Angeles-appcast.io-6 days ago

searching for a newRegional Vice Presidentto oversee Case Management and Utilization Management for theirLos Angeles region. This is a very exciting time to join this team as they are currently experiencing very positive growth! The CEO is focused...

Regional Director of Pharmacy–Infusion/Oncology Operations

Direct Jobs-Los Angeles-appcast.io-5 days ago

Strong knowledge of medication management standards, pharmacy regulations, and accreditation requirements • Experience overseeing pharmacy operations including medication procurement, storage, distribution, and utilization management • Proven ability...

Medical Director - Clinical Advocacy and Support - Remote - Surgeon and Hawaii or West Coast Pr[...]

UnitedHealth Group-Los Angeles-appcast.io-4 days ago

utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other...