Utilization jobs in Los Angeles

Molina Healthcare is hiring for a remote Pharmacist, UM/Prior Auth. Essential Job Duties Provides support and subject matter expertise for pharmacy formulary liaison activities between the business and its customers (members, providers and pharmacies) to determine coverage and informative drug use.

Under the supervision of the Utilization Review Manager, the Utilization Review Assistant provides support to ensure that all utilization management documentation and information requirements, including electronic communication, are met. Work areas include payer notification, authorization managemen

We are hiring a Travel Nurse - RN in the Utilization Review (UR) department located in Orange, California. This position offers competitive pay of $2,747 per week. Responsibilities Include Conducting comprehensive utilization reviews to ensure appropriate patient care and resource allocation Assessi

Department: HS - UM Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Description About the Role The Part‑Time Medical Director – Utilization Management, Outpatient Services provides physician oversight for medical necessity, appropriateness, and utilization decisions across Astrana Healt

Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive

Medical Director - Utilization Management (Part Time) Department: HS - UM Employment Type: Part Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Reporting To: Dr. Dinesh Kumar Description About the Role The Part‑Time Medical Director – Utilization Management, Outpatient Services pro

Your Role The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Utilization Management - will report to the Sr. Medical Director, Util

Job Summary The Utilization Review (UR) LVN supports the Mission of Pipeline Health through the provisision of disctinctive and compassionate care to our patients. This position is responsible for utilization review, including assessment of patient’s medical necessity criteria for admission and cont

Current Emanate Health Employees - Please log into your Workday account to apply Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team tha

Current Emanate Health Employees - Please log into your Workday account to apply Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team tha

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, functioning as both a care provider and care plan to those individuals we serve. Our Health Plan Services team plays a critical role in our partici

Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive

Job Summary: Responsible for day-to-day review, coordination and management of Clinical denials requiring background and understanding from a provider operational and payer logistical perspective. Auditor must work with a diverse group of other health care professionals to conduct review and appeal

This position supports the Mission of the Hospital through the provision of distinctive and compassionate care to our patients. This position provides clerical support to the Case Management Department by assuring continuous flow of daily activities; duties and information flow between all hospital

CalOptima

Behavioral Health Utilization Management Medical Case Manager CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, functioning as both a care provider and care plan to those individuals we serve. Our Health Plan Services team plays a critical role in our partici

WelbeHealth

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, functioning as both a care provider and care plan to those individuals we serve. Our Health Plan Services team plays a critical role in our partici

Job Summary Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the

Job Summary Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the