Current jobs related to Utilization Management Specialist - Los Angeles, California - APLA Health
-
Client Support Operations Manager
2 weeks ago
Los Angeles, California, United States Specialist Direct Full timeAbout Specialist DirectWe are a leading telehealth company specializing in organ transplant services. Our cloud-based diagnostic solutions have improved organ utilization and increased placements nationwide.The RoleAs our Client Support Manager, you will oversee our 24/7 Client Support team, ensuring seamless client interactions and efficient workflow...
-
Utilization Management Director
3 weeks ago
Los Angeles, California, United States Management Business Solutions Full timeJob Title: Utilization Management DirectorManagement Business Solutions is seeking a highly skilled Utilization Management Director to join our team. As a key member of our healthcare operations team, you will be responsible for managing the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center.Key...
-
Healthcare Manager
3 weeks ago
Los Angeles, California, United States Management Business Solutions Full timeJob SummaryManagement Business Solutions is seeking a skilled Healthcare Manager to lead our Utilization Management Program. As a key member of our team, you will be responsible for managing the day-to-day operations of the program, ensuring cost-effective and quality patient care through appropriate resource utilization.Key Responsibilities:Develop and...
-
Client Support Operations Manager
3 weeks ago
Los Angeles, California, United States Specialist Direct, Inc. Full timeAbout Specialist DirectSpecialist Direct, Inc. is a pioneering telehealth company revolutionizing organ transplant care in the US. Founded in 2015, our cloud-based diagnostic solutions have significantly improved organ utilization and placement rates.The RoleWe are seeking a seasoned Client Support Manager to lead our 24/7 Client Support team. As a key...
-
Roofing Technical Services Specialist
3 weeks ago
Los Angeles, California, United States Roof Repair Specialist Full timeJob OverviewWe are seeking a skilled Roofing Technical Services Specialist to join our team at Roof Repair Specialist. As a key member of our team, you will be responsible for diagnosing and repairing complex roofing issues, ensuring the highest level of quality and customer satisfaction.Key Responsibilities:Conduct thorough inspections of residential,...
-
RN Case Manager Utilization Specialist
2 weeks ago
Los Angeles, California, United States Kaiser Permanente Full timeJob Summary:Kaiser Permanente seeks a skilled RN Case Manager Utilization Specialist to coordinate and screen for the appropriateness of admissions and continued stays. This role requires collaboration with physicians to make recommendations for alternate levels of care when patients do not meet medical necessity for inpatient hospitalization. The ideal...
-
Utilization Management Director
3 weeks ago
Los Angeles, California, United States APLA Health Full timeJob SummaryWe are seeking a highly skilled Utilization Management Director to join our team at APLA Health. As a key member of our healthcare operations team, you will be responsible for managing the daily operations of Utilization Management (UM) at APLA Health and Wellness (APLAHW).Key ResponsibilitiesDevelop and implement a standardized Utilization...
-
Nurse Manager
3 weeks ago
Los Angeles, California, United States Necnic Group, LLC Full timeNurse Manager - Utilization ManagementAt Necnic Group, LLC, we are seeking a skilled Nurse Manager to lead our Utilization Management Program. As a key member of our team, you will be responsible for ensuring cost-effective and quality patient care by optimizing resource utilization.Key Responsibilities:Develop and maintain policies and procedures for...
-
Nurse Manager
3 weeks ago
Los Angeles, California, United States Necnic Group, LLC Full timeNurse Manager - Utilization ManagementAt Necnic Group, LLC, we are seeking a highly skilled and experienced Nurse Manager to lead our Utilization Management Program. This is a critical role that requires a strong understanding of healthcare operations and management principles.Key Responsibilities:Develop and maintain policies and procedures for Utilization...
-
Clinical Care Coordinator
3 weeks ago
Los Angeles, California, United States Sante Health Full timeClinical Care Coordinator OpportunityWe are seeking a skilled Clinical Care Coordinator to join our Utilization Management team. This role will be responsible for coordinating care for patients post-discharge from inpatient and Emergency Department care, as well as those with complex medical conditions and medication adherence. The goal is to reduce ED...
-
Clinical Resource Utilization Specialist
3 weeks ago
Los Angeles, California, United States East Los Angeles Doctor Hospital Full timeJob SummaryEast Los Angeles Doctor Hospital seeks a skilled Clinical Resource Utilization Specialist to join our team. As a key member of our healthcare team, you will be responsible for managing clinical resource utilization and documentation affecting reimbursement. This role requires strong communication and collaboration skills, as well as the ability to...
-
Clinical Utilization Review Specialist
2 months ago
Los Angeles, California, United States UCLA Health Full timeUnlock Your Potential in HealthcareAt UCLA Health, we're seeking a highly skilled Clinical Utilization Review Specialist to join our team. As a key member of our healthcare organization, you'll play a vital role in promoting high-quality, cost-effective medical care.Key Responsibilities:Apply clinical acumen and applicable policies and guidelines in the...
-
Database Management Support Specialist
3 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeJob Title: Database Management Support SpecialistJob Summary:We are seeking a highly motivated and detail-oriented Database Management Support Specialist to join our team at MedPOINT Management. In this role, you will be responsible for ensuring accurate and timely provider profile creation in our Client IPA databases.Key Responsibilities:Create provider...
-
Director of Utilization Management
3 weeks ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryAs a key member of our team, the Director of Utilization Management will be responsible for developing and managing programs that emphasize appropriate admissions, concurrent and retrospective review of care, and other integrated functions to promote a centralized, coordinated, interdisciplinary process in the continuum of care.Key...
-
Director of Utilization Management
4 weeks ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryDevelops, manages, and directs the Utilization Management programs in a Service Area or a Medical Center. Develops and manages programs that emphasize appropriate admissions, concurrent, and retrospective review of care. May also be responsible for other integrated functions such as Discharge Planning, Case Management program, Outside Utilization...
-
Utilization Management Director
3 weeks ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryAs a key member of the Kaiser Permanente team, the Director of Utilization Management will be responsible for developing and managing programs that emphasize appropriate admissions, concurrent and retrospective review of care, and other integrated functions to promote a centralized, coordinated, interdisciplinary process in the continuum of...
-
Storeroom/Utility/Cleanliness Specialist
3 weeks ago
Los Angeles, California, United States JACKMONT HOSPITALITY INC Full timeJob SummaryWe are seeking a highly detail-oriented and organized individual to join our team as a Storeroom/Utility/Cleanliness Specialist. The successful candidate will be responsible for maintaining the cleanliness and organization of our stores, ensuring a positive guest experience.Key Responsibilities:Ensure all trash is disposed of in a timely and...
-
Director of Utilization Management
3 weeks ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryAs a key member of our team, the Director of Utilization Management will be responsible for developing and managing programs that emphasize appropriate admissions, concurrent and retrospective review of care, and other integrated functions to promote a centralized, coordinated, interdisciplinary process in the continuum of care.Key...
-
Director of Utilization Management
2 weeks ago
Los Angeles, California, United States Kaiser Permanente Full timeJob Summary:Develops, manages, and directs the Utilization Management programs in a Service Area or a Medical Center. The ideal candidate will develop and manage programs that emphasize appropriate admissions, as well as concurrent and retrospective review of care. This role may also be responsible for other integrated functions such as Discharge Planning,...
-
RN Manager of Utilization Management
3 weeks ago
Los Angeles, California, United States healthcarerecruitmentpartners Full timeRN Manager of Utilization Management Job DescriptionJob Summary:The RN Manager of Utilization Management is responsible for overseeing the coordination of services through an interdisciplinary process across the continuum of care. This role expands the Care Management focus, balancing individually identified patient and family needs with cost-effective...
Utilization Management Specialist
2 months ago
We are seeking a highly skilled Utilization Manager to join our team at APLA Health. The successful candidate will be responsible for managing the daily operations of Utilization Management (UM) and ensuring that all processes, programs, and operations meet internal, government, health plan/IPA, and medical group requirements.
Key Responsibilities- Develop and implement a standardized Utilization Management Program to ensure compliance with regulatory requirements.
- Ensure staff competency through training and evaluation using inter-rater reliability tools and evidence-based criteria.
- Develop, implement, and maintain policies and procedures for medical utilization management functions.
- Establish and maintain collaborative relationships with internal and external stakeholders, including the Chief Medical Officer, clinic directors, and site medical directors.
- Participate in data collection, analysis, and reporting to identify trends and opportunities for process improvements.
- Supervise a team of referral coordinators, patient engagement and retention specialists, and medical records coordinators.
- Optimize processes and workflows for the UM staff to ensure efficient and effective operations.
- Five years of experience in utilization/care management in a clinical or managed care setting.
- Four years of management/supervisory experience in a formal or informal role.
- Bachelor's degree in Nursing (RN with active California certification) or other healthcare-related field.
- Basic computer skills in a Windows operating environment, including Microsoft Word, Excel, and email.
- Knowledge of InterQual and/or Milliman software.
- Knowledge of electronic health records systems, such as eClinicalWorks.
- Knowledge of ambulatory healthcare delivery and management.
- Knowledge of NCQA, DMHC, CMS, and other regulatory agency requirements.
This is a primarily office-based position that requires occasional bending, reaching, stooping, lifting, and moving of office materials weighing 25 pounds or less.
The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper.
The successful candidate must possess a valid California driver's license, proof of auto liability insurance, and have the use of a personal vehicle for work-related purposes.
