Utilization Manager Jobs in Rancho Cucamonga
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Search Results - Utilization Manager Jobs in Rancho Cucamonga
Inland Empire Health Plan-Rancho Cucamonga
Inland Empire Health Plan seeks a Senior Director, Pharmaceutical Services to lead strategic direction, clinical oversight, and operational execution of IEHP’s pharmacy program for Medi-Cal, DSNP and Exchange.
You will drive utilization management...
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Care Navigators On Demand-Rancho Cucamonga
and management of clinical care coordination, utilization management, discharge planning, and outcomes management. Oversees the MediCal TAR process... Manages the systems, processes, and outcomes of clinical care teams and programs designed to address clinical...
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Inland Empire Health Plan-Rancho Cucamonga
clinical and financial value
• Monitor formulary, rebate, and utilization management programs to maximize clinical and financial value
• Ensure PBM performance metrics align with pricing strategy, member satisfaction, and health outcomes
• Direct pharmacy...
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Rancho Cucamonga
standards and LEAN project initiatives are met. The Utilization Management Team Lead, RN collaborates with UM leadership to manage daily operations of clinical staff, oversee inventory management, and ensure all staff meet the organization's expectations...
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icims.com -
Inland Empire Health Plans-Rancho Cucamonga
Director, Pharmaceutical Services leads the strategic direction, clinical oversight, and operational execution of IEHP’s pharmaceutical program for IEHP Medi Cal, DSNP, and Exchange members, and is responsible for ensuring appropriate utilization management...
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Rancho Cucamonga
scope as indicated by the Utilization Management Guide approved by the Utilization Management Subcommittee.
8. Obtain Member discharge dates through daily calls, Electronic Medical Record or memo submissions to contracted and non-contracted facilities.
9. ..
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icims.com -
Inland Empire Health Plan-Rancho Cucamonga
and margin-improvement initiatives across medical spend categories and administrative spend categories., including high cost claim management, care model optimization, provider incentive refinement, and avoidable utilization reduction.
Partners with Clinical...
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appcast.io -
Rancho Cucamonga
with Utilization Management, Behavioral Health, or Care Management departments.
12. Assist Clinical Pharmacist in review of Member’s medication regimen and assist in care coordination internally with Utilization Management, Behavioral Health, or Care Management...
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icims.com -
Rancho Cucamonga
utilization management through evidence based UM criteria, audit ready documentation, and strengthened cost containment protocols. The role demonstrates advanced expertise in CMS, DHCS, DMHC, MDV audits and NCQA survey readiness and oversight, leading...
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icims.com -
Rancho Cucamonga
and margin-improvement initiatives across medical spend categories and administrative spend categories., including high cost claim management, care model optimization, provider incentive refinement, and avoidable utilization reduction.
Partners with Clinical...
Read more
icims.com -
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