Utilization Review Jobs in San Diego
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Search Results - Utilization Review Jobs in San Diego
eTeam Inc - Secondary-San Diego
safe and effective discharge planning.
Required Qualifications
• Minimum 2 years of recent hospital case management experience
• Active Registered Nurse License in the state of practice
• BLS (AHA) certification
• Strong knowledge of utilization...
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eviCore healthcare-San Diego
Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
Reviews appeals for denied services related...
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Akua Mental Health-San Diego
to foster peer support, skill development, and relapse prevention.
• Care Coordination: Collaborate with multidisciplinary team members to coordinate care, advocate for clients' needs, and ensure continuity of treatment.
• Utilization Review: We conduct...
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eviCore healthcare-San Diego
Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
Reviews appeals for denied services related...
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Sharp Community Medical Group-San Diego
to:
• Establish and review the plan of care at intervals no greater than 15 days
• Determine continued eligibility before each recertification period (§ 418.21(a))
• Participate in case conference meetings as requested
• Work with the Utilization Review...
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eviCore healthcare-San Diego
Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
Reviews appeals for denied services related...
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Evolve Adolescent Behavioral Health-San Diego
actions to resolve problems to promote continuous improvement in the delivery of treatment
• Monitor all program documentation of treatment plans and clinical notes for Utilization Review
• Audit client documentation weekly to confirm record-keeping system...
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The Rehabilitation Institute of St. Louis - St. Peters, an affiliation of BJC HealthCare and Encompass Health-San Diego
a graduate degree is preferred.
• Three years of hospital-based Case Management experience, including Utilization Review and Discharge Planning experience.
• May be required to work weekdays and/or weekends, evenings and/or night shifts.
• May be required...
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Reliant Rehabilitation-San Diego
to community patient care, utilization review, case management, administrative staff/department head, and family conference activities and communications; - establishing and maintaining a good working relationship with other health care professionals...
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San Diego
Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations
Responsibilities:
MAJOR DUTIES AND RESPONSIBILITIES:
• Reviews medical files and provides recommendations for utilization review, chart reviews...
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icims.com -
Sharp HealthCare-San Diego
required to type proficiently and accurately; Have the ability to type a minimum of 30 words per minute with 0-2 errors; Have the ability to proof work.
Knowledge of insurance, utilization review, scheduling requirements and support of front desk...
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appcast.io -
eviCore healthcare-San Diego
Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
Reviews appeals for denied services related...
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UC San Diego-San Diego
Demonstrated utilization review/discharge planning experience.
• Knowledge of payer industry, resource management, reimbursement, and evidence-based clinical practice is essential.
• Proficiency in Information Systems, databases, and computer programs...
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eviCore healthcare-San Diego
Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
Reviews appeals for denied services related...
Read more
Kaiser Permanente-San Diego
provided.
• Provides education to providers and staff via presentations, newsletters, formal utilization reviews, and one-on-one interactions.
• Performs drug utilization review, comprehensive medication review, and/or medication reconciliation...
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