Top 33 Utilization management Jobs in Calexico, Ca

Lead Care Manager
Serene Health —Calexico, CA
- $20 - $25 an hour
- Full-time
- Background check
- Experience working with individuals with developmental disabilities
- Spanish
- Mileage reimbursement
- Paid holidays
Quick Apply
5d
Clinical Case Manager
Pioneers Memorial Healthcare District / PMHD —Brawley, CA
- Spanish
- Nursing
- Medicine
Quick Apply
ED Access Case Manager
PIONEERS MEMORIAL HEALTHCARE DISTRICT —Brawley, CA
- $46.69 - $55.97 an hour
- Full-time
- Nursing
- Hospital
- Writing skills
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Clinic RN I
PIONEERS MEMORIAL HEALTHCARE DISTRICT —Brawley, CA
- $39.09 - $44.93 an hour
- Per diem
- Spanish
- CPR Certification
- Nursing
Quick Apply
Case Manager (RN)
PIONEERS MEMORIAL HEALTHCARE DISTRICT —Brawley, CA
- $46.37 - $53.30 an hour
- Full-time
- Spanish
- Nursing
- Medicine
Quick Apply
Clinic RN - Enhanced Care Management
PIONEERS MEMORIAL HEALTHCARE DISTRICT —Brawley, CA
- $31.20 - $41.17 an hour
- Temporary
- Spanish
- CPR Certification
- Nursing
Quick Apply
Clinic RN
PIONEERS MEMORIAL HEALTHCARE DISTRICT —Brawley, CA
- $39.09 - $44.93 an hour
- Full-time
- Spanish
- CPR Certification
- Nursing
Quick Apply
Director of Nursing, Infusion Therapy
GLIA HEALTH MANAGEMENT LLC —El Centro, CA
- $120,000 - $160,000 a year
- Full-time
- Nursing
- RN License
- 5 years
- Paid training
- Paid holidays
Quick Apply
Infect Disease Pharmacist
PIONEERS MEMORIAL HEALTHCARE DISTRICT —Brawley, CA
- $70.57 - $81.93 an hour
- Full-time
- Acute care
- Patient monitoring
- Hospital
Quick Apply
Physical Therapy Assistant
PIONEERS MEMORIAL HEALTHCARE DISTRICT —Brawley, CA
- $33.84 - $39.29 an hour
- Per diem
- CPR Certification
- Anatomy knowledge
- Management
Quick Apply
Perioperative Services Registered Nurse II
PIONEERS MEMORIAL HEALTHCARE DISTRICT —Brawley, CA
- $42.72 - $49.11 an hour
- Weekends as needed
- Nursing
- RN License
- PALS Certification
Quick Apply
Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- Spanish
- Nursing
- Microsoft Excel
- Travel reimbursement
- Health savings account
Quick Apply
Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)
UT Health Science Center at San Antonio —United States
- Hospital
- Outpatient experience
- 3 years
Quick Apply
Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
Quick Apply
Clinical Operations EMR Consultant
Maxwell TEC —United States
- $55 - $85 an hour
- Part-time
- Remote
- RN License
- Mid-level
- Home Health
Quick Apply
Family Medicine Medical Director Utilization Management
Amerihealth Caritas —United States
- Weekends as needed
- Hybrid work
- Medicine
- Physical & Rehabilitation Medicine
- 3 years
- Paid holidays
- Health insurance
Inpatient Medical Coding Quality Auditor
Pena4 Inc. —United States
- $80,000 - $90,000 a year
- 8 hour shift
- Remote
- 5 years
- US work authorization
- Senior level
- Health insurance
- Dental insurance
Quick Apply
7d

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Ability to organize your own schedule, maximizing your time. You will be gaining hours for licensure (MFT intern or psychological assistant (in Ph.D. program),…
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LVN Case Manager
Vynca —El Centro, CA
Clean driving record, valid driver's license, and reliable transportation. Active California Licensed Vocational Nurse (LVN) license.
$32 - $40 an hour

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RN, LSW, LISW, Care Manager - Columbus
Careforth —Columbus, OH
Ability and flexibility to travel (usually by car) within assigned geographic area; valid driver’s license and car insurance required.
$62,657 - $84,173 a year
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Conducts utilization reviews of behavioral health cases to determine medical necessity…
5d

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utilization management jobs near calexico, ca

Lead Care Manager

Serene Health -
Calexico, CA

Quick Apply

Job Details

Full-time
$20 - $25 an hour
5 days ago

Benefits

Mileage reimbursement
Paid holidays
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Employee assistance program
Vision insurance
Employee discount
Referral program

Qualifications

Live chat
Email customer support
Texting/chatbox tools
High school diploma or GED
Driver's License
Phone customer support
Driving
Typing
Proofreading

Full Job Description

Empowering Wellness, Transforming Lives

Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being.

As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities.

Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people's lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members.

A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual's contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work!

Job Summary:

The official job title is Lead Care Manager (LCM).

The Lead Care Manager (LCM) role involves developing personalized care plans, coordinating member services, and collaborating closely with members and families, as well as Primary Care Providers to ensure they receive necessary medical treatment and support. The LCM will consult with members to determine their needs, develop individualized action plans, and work with care teams to manage the member experience effectively. Providing emotional support, resolving administrative issues, and ensuring timely access to care are key aspects of the position. Compassion, healthcare knowledge, and exceptional customer service are essential qualities for assisting members in becoming self-sufficient in health. The LCM will work with a diverse population of members enrolled in the Enhanced Care Management program, which may involve one or multiple members from the population of focus section below.

Responsibilities:

Interview members to assess medical and social determinant of healthcare gaps and provide education about their condition and medication, while developing individualized care plans.

Respond to member inquiries and concerns, ensuring adherence to hospital and legal requirements.

Collaborate with interdisciplinary teams, locate medical and social resources, and coordinate social service plans.

Maintain on-going contact with members, via telehealth and in-person visitation.

Advocate for members, consult with healthcare providers, arrange appointments and treatment plans, evaluate member progress, and assist with healthcare barriers.

Maintain empathy and professionalism while contacting members and families.

Supporting behavioral health coordination, Substance Abuse and Community Resources.

Perform additional duties as assigned.

Populations of Focus:

Individuals experiencing homelessness: Lacking a fixed, regular, and adequate nighttime residence.

Individuals at risk for avoidable hospital or emergency department utilization: Five or more emergency room visits in a six-month period that could have been avoided with appropriate outpatient care or improved treatment adherence.

Individuals with Serious Mental Health and/ or substance use disorder needs: Adults who meet the eligibility criteria for participation in, or obtaining services through Specialist mental health services or the Drug Medi-Cal organized delivery system or Drug Medi-Cal program.

Individuals transitioning from incarceration/Justice Involved: Adults transitioning from a correctional setting or transitioned from a correction setting within the past 12 months, or children and youth who are transitioning from a youth correctional facility or transitioned from being in a youth correctional facility within the past 12 months.

Adults living in the community and at risk for long-term care institutionalization: Adults who are living in the community who meet the SNF Level of Care criteria; or who require lower-acuity skilled nursing or equipment for prevention, diagnosis, or treatment of acute illness or injury.

Adult nursing facility residents transitioning to the community: Adult nursing residents who are interested in moving out of the institution, and are likely candidates to do so successfully, and are able to reside continuously in the community.

Children and youth enrolled in California Children's Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS condition: Children and youth enrolled in CCS or CCS WCM and are experiencing at least one complex social factor influencing their health.

Children and Youth Involved in Child Welfare

Individuals with Intellectual/ Developmental Disabilities: Adults who have a diagnosed I/ DD and qualify for eligibility in any other adult ECM population of focus.

Pregnant and Postpartum individuals; Birth Equity Population of Focus: Adults and youth who are pregnant or postpartum and qualify for eligibility in any other adult or youth ECM POF, or are subject to racial and ethnic disparities.

Education and Experience:

High school diploma or GED required.

Minimum of 1 year experience in case management, member care, customer
service, call center, or member care required.

Valid California driver's license and valid vehicle insurance required.

MA certificate or medical terminology knowledge preferred.

Required Skills/Abilities:

Excellent communication, interpersonal, customer service and organizational skills.
Bilingual in Spanish (Preferred).

Computer skills for documentation, email and chat support.

Proficient skills in working independently and collaboratively in a team to provide member care.

Proficiency in multitasking, organization, and attention to detail is required for effectively providing care to multiple members simultaneously.

Candidates should exhibit the capability to utilize resources effectively for problem-solving while maintaining composure under pressure in a compassionate manner.

Applicants must demonstrate proficient speaking, reading, and typing abilities and possess strong proofreading skills.

Physical Requirements:

Must be able to travel using personal vehicle to complete outreach visits. Mileage reimbursement for the use of your vehicle is at a standard rate.

Must successfully complete and maintain current Tuberculosis (TB) testing and clearance in accordance with company policy and applicable local/state health regulations as a condition of employment.

Prolonged periods of sitting at an office desk on the computer.

Lifting: Able to lift up to 15lbs.

Benefits

Our full-time employees are eligible for the following benefits enrollment after 60 days of employment:

Medical, Dental, & Vision Benefits: We have various insurance options for you and your family.

Short & Long-Term Disability Benefits: Protection when you need it most.

Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones.

Flexible Spending Accounts: Manage your finances with flexibility.

Employee Assistance Program (EAP): Support when life throws challenges your way.

401(K): Building your financial future with us. Effective after 1 year of employment.

Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.

Paid Holidays: Quality time to enjoy celebrations.

Employee Referral Program: Share the opportunities and reap the rewards.

Company Discount Program: Enjoy savings on everyday expenses and memberships.

Equal Employment Opportunity

Optima Medical Management Group and its divisions are an Equal Opportunity Employer. Optima MMG is committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state or local laws. Optima MMG is committed to providing reasonable accommodation for individuals with disabilities.

Pre-Employment

Optima Medical Management Group is a drug-free workplace. Employment is contingent upon a successful pre-employment drug screening and background check.

Quick Apply

Refine Your Search

utilization management jobs in calexico, ca

Lead Care Manager

Clinical Case Manager

ED Access Case Manager

Clinic RN I

Case Manager (RN)

Clinic RN - Enhanced Care Management

Clinic RN

Director of Nursing, Infusion Therapy

Infect Disease Pharmacist

Physical Therapy Assistant

Perioperative Services Registered Nurse II

Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.

Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)

Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)

Clinical Operations EMR Consultant

Family Medicine Medical Director Utilization Management

Inpatient Medical Coding Quality Auditor

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