Utilization Manager Jobs in San Jose
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Search Results - Utilization Manager Jobs in San Jose
San Jose-icims.com-
Pharmacy Utilization Management (RxUM), the Pharmacy Technician - Utilization Management (RxUM) is responsible for the technical/clinical review of the utilization management authorization request with a medication component.
Commitment to Quality...
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San Jose-tiptopjob.com-
to utilization management, care management, quality improvement, and operational teams.
• Interpret and apply Medicaid regulations, medical policies, and nationally recognized clinical guidelines to support program compliance.
• Collaborate with clients...
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San Jose-icims.com-
Services is responsible for providing patient-specific medication reviews and developing recommendations for medical drug utilization management (RxUM), Medication Therapy Management (MTM), medication adherence, pharmacy clinical quality, including...
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San Jose-tiptopjob.com-
and clinical review professionals to ensure high:quality medical necessity reviews, utilization management, and regulatory compliance. The role focuses on driving clinical quality, operational efficiency, workforce planning, budget management, and continuous...
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San Jose-icims.com-
Bachelors or Masters degree in Social Work, Behavioral Health Or Mental Health, Nursing or Other related health field preferred.
• Two or more year's experience with the population of the facility preferred.
• Previous experience in utilization management...
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San Jose-enlyte.com-
Utilization Management, Acute Care, Orthopedics, Rehabilitation, Rehab, CCM, Certified Case Manager, CDMS, Certified Disability Management Specialist, CRC, Certified Rehab Certificate, CRRN, Certified Rehab Registered Nurse, COHN, Certified...
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San Jose-icims.com-
Management
• Work closely with in and out of network hospitals, facilities, healthcare providers, and ancillary vendors to coordinate effective care for members based on MD, AMD and utilization management guidelines.
• Primary contact for intake of Letter...
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San Jose-tiptopjob.com-
determinations related to behavioral health and autism treatment services.
• Conduct peer:to:peer consultations with providers and apply evidence:based clinical criteria to support appropriate care decisions.
• Provide clinical guidance to utilization management...
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San Jose-icims.com-
Requirements
• Three (3) or more years of any individual or combined experience in Quality Assurance, Utilization Management, Case Management, provider liaison duties, and/or clinical experience in a hospital/clinical setting
• Experience preferably in an HMO...
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San Jose-tiptopjob.com-
to utilization management, quality, case management, and operational teams.
• Interpret and apply Medicaid regulations, medical policies, and rehabilitation treatment guidelines to support program compliance.
• Collaborate with clients and internal stakeholders...
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San Jose-tiptopjob.com-
evaluations.
• Conduct peer:to:peer consultations with providers and apply evidence:based clinical criteria to support appropriate testing and treatment decisions.
• Provide clinical guidance to utilization management, quality, case management, and operational...
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