Utilization Manager Jobs in San Jose
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Search Results - Utilization Manager Jobs in San Jose
San Joseicims.com
of the Utilization Management Manager, the Utilization Management Nurse is responsible for prospective and concurrent/retrospective review of referrals ensuring regulatory requirements are being met as they relate to language readability and appropriate citation...
Altais Health SolutionsSan Joseappcast.io
Altais Health Solutions seeks a Medical Director of Utilization and Medical Management to lead the development and implementation of utilization management policies, ensuring high-quality, efficient care across the continuum.
You will collaborate...
San Joseicims.com
Three (3) or more years of any individual or combined experience in quality assurance, utilization management, case management, and/or health care informatics
• Experience in an HMO or managed care setting preferred
• Associate's degree in Nursing from...
AltaisSan Joseappcast.io
for physicians and their patients. The Medical Director of Utilization and Medical Management will report directly to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation, and work closely with the Altais Clinical...
San Josepacificclinics.org
to staff/managers regarding these items.
• Runs violation report, productivity report, and scheduling report; checks for errors or issues needing to be addressed; communicates these issues in a timely manner.
Payor/Utilization Management
• Verifies...
E2E Alignment Healthcare USA, LLCSan Joseappcast.io
clinical, quality, utilization, risk adjustment, and financial performance across assigned provider networks and geographic markets. This role partners closely with Network Management, Quality, Risk Adjustment, Pharmacy, Clinical Operations, and providers...
San Joseicims.com
Health Plan operations and department business needs are successful
Qualifications:
Education & Requirements
• Two (2) years or more case management, utilization management in managed care setting or related experience in a health care delivery...
GQR HealthcareOakland, 32 mi from San Jose
This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions...
San Joseicims.com
reviews and develop recommendations using established medical treatment protocols and clinical practice guidelines in compliance with regulatory timelines and standards
1. Medical drug utilization management (RxUM) - Evaluate adjudicate prior...
San Joseicims.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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