Top 67 Utilization management Jobs in Lancaster, Ca

Utilization Management Lead
HIGH DESERT MEDICAL CORP, A MEDICAL GRP —Lancaster, CA
- $25.19 - $37.18 an hour
- Microsoft Word
- Mid-level
- High school diploma or GED
- Paid time off
- Parental leave
Quick Apply
Acute Case Manager
HIGH DESERT MEDICAL CORP, A MEDICAL GRP —Lancaster, CA
- $31.76 - $43.70 an hour
- Full-time
- Acute care
- CPR Certification
- Nursing
- Paid time off
- Parental leave
Quick Apply
11d
Regional Office Manager
AXIOM MEDICAL MANAGEMENT LLC —Palmdale, CA
- $75,000 - $90,000 a year
- Full-time
- Spanish
- Mid-level
- Organizational skills
- Health insurance
- Dental insurance
Program Coordinator
Tarzana Treatment Centers, Inc —Lancaster, CA
- $29.58 - $37.02 an hour
- Pass drug screening
- Mid-level
- Master's degree
- Paid holidays
- Health insurance
Quick Apply
Case Manager
Project 180 —Palmdale, CA
- $25.24 - $30.62 an hour
- Weekends as needed
- Background check
- Spanish
- Computer literacy
Quick Apply
LVN Case Manager - Inpatient
SIERRA MEDICAL GROUP, INC —Palmdale, CA
- $33 - $36 an hour
- Evenings as needed
- Acute care
- Spanish
- LVN
- Disability insurance
- Health insurance
Quick Apply
Clinical Care Manager - CA
Independent Living Systems —Lancaster, CA
- $26.00 - $43.81 an hour
- Full-time
- Spanish
- CPR Certification
- Master of Social Work
Mental Health Therapist- Teen Residential Treatment
Ascend Healthcare —Santa Clarita, CA
- $75,000 - $80,000 a year
- Full-time
- Background check
- LMFT
- Licensed Clinical Social Worker
- Health savings account
- Health insurance
Quick Apply
MENTAL HEALTH PROGRAM MANAGER I / EMERGENCY APPOINTMENTS HOMELESSNESS
Los Angeles County Department of Human Resources —Los Angeles County, CA
- $132,009.36 - $205,301.76 a year
- Online Application
- LMFT
- Nursing
- RN License
CONTRACT PROGRAM AUDITOR / EMERGENCY APPOINTMENT HOMELESSNESS
Los Angeles County Department of Human Resources —Los Angeles County, CA
- $79,689.84 - $107,390.16 a year
- Online Application
- Hospital
- Mid-level
- Administrative experience
MENTAL HEALTH PROGRAM MANAGER II / EMERGENCY APPOINTMENTS HOMELESSNESS
Los Angeles County Department of Human Resources —Los Angeles County, CA
- $141,907.20 - $220,694.40 a year
- Online Application
- LMFT
- Nursing
- RN License
Counselor I
Tarzana Treatment Centers, Inc —Palmdale, CA
- $27.77 - $31.36 an hour
- Full-time
- Psychiatry
- 5 years
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
Care Advocate - Care Delivery
Wider Circle —Lancaster, CA
- $22.22 - $25.51 an hour
- Full-time
- Hybrid work
- Computer literacy
- Mid-level
- High school diploma or GED
- Health savings account
- AD&D insurance
Quick Apply
Counselor II
Tarzana Treatment Centers, Inc —Lancaster, CA
- $28.03 - $32.39 an hour
- Full-time
- Psychiatry
- 5 years
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
3d
Counselor IV
Tarzana Treatment Centers, Inc —Palmdale, CA
- $36.79 - $44.23 an hour
- Full-time
- Psychiatry
- 5 years
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
11d
Program Coordinator/Clinical Supervisor
Help Group —Palmdale, CA
- $80,000 - $90,000 a year
- Full-time
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Clinic Supervisor- East Hollywood
JWCH Institute —Palmdale, CA
- $58,189 - $63,740 a year
- Full-time
- Spanish
- Microsoft Outlook
- HIPAA
- Profit sharing
- Mileage reimbursement
Quick Apply
8d
Registered Nurse Surgery Center Per Diem
Fresenius Medical Care —Palmdale, CA
- $41.04 - $68.41 an hour
- Part-time
- Nursing
- Heavy lifting
- RN License
12d
Field Registered Nurse - Home Health - Per Diem/Days - Req# 2117935698
Antelope Valley Medical Center —Lancaster, CA
- $53.75 - $88.74 an hour
- Per diem
- CPR Certification
- Nursing
- RN License
Quick Apply
PSYCHIATRIC SOCIAL WORKER II
Los Angeles County Department of Human Resources —Los Angeles County, CA
- $87,954.72 - $112,272.00 a year
- Weekends as needed
- Psychiatry
- Licensed Clinical Social Worker
- Mid-level
- Health insurance
- Retirement plan

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Utilization Management Lead

HIGH DESERT MEDICAL CORP, A MEDICAL GRP -
Lancaster, CA

Quick Apply

Job Details

$25.19 - $37.18 an hour

Benefits

RSU
Paid time off
Parental leave

Qualifications

Microsoft Word
Statistics
Staff supervision
Confidential information handling
Data analysis reporting
Presentation software
Team supervision
Performance Reporting
Data summary reports
High school diploma or GED
Grammar Experience
Task assignment

Full Job Description

The UM Lead works under the direction of their Supervisor and UM Director to oversee day to day activities of the Referral Management Department by assisting the Medical Director and Physician Reviewers with obtaining adequate information for making referral determinations, including gathering necessary medical records, clinical review guidelines, health plan and/or regulatory policies, financial/benefit/coverage information, and/or other documentation as needed or requested.

Summary of Duties:

Coordinates accurate and timely processing of pre-service referrals by gathering necessary medical records through use of NextGen EHR and/or contacting treating providers as necessary or requested by MD Reviewer.
Ensures accurate eligibility and benefit verification.
Ensures use of appropriate member notification templates.
Facilitates timely communication of authorizations to providers, members, and health plans by monitoring the clinical review process to ensure determinations are made within the appropriate timeframe.
Communicate with health plans when issues with coverage or responsibility are in question.
Under the direction of the UM Manager and Supervisor, provide training and education to other UM Coordinators, Nurses, and Phisician Reviewers.
Assist with department coverage for lunches, breaks, and absences.
In collaboration with UM Manager and Supervisor, prepares and delivers reports, logs, and communication internally and externally.
Assists with development of clinical review processes to ensure workload balancing for timely and accurate workflow and production.
Ensures consistency with member notifications by monitoring volume of clinical review queues.
Monitors utilization patterns and notifies UM Manager and Supervisor of potential utilization issues.
Ensures excellent customer service is provided to our members, providers, vendors, and internal customers.
Assists with department phone coverage during normal business hours.
Maintain up to date knowledge of MediCare, MediCal, managed care, and other insurance benefits and requirements.
Communicate current regulations, benefits, and requirements to clinical review team and other staff as directed by UM Manager and Supervisor.
Provide consistent clinical review updates to UM Manager and Supervisor.
Providers resource information to patients, families, and the community when necessary.
Creatively contributes to problem solving for outcome and process improvement.
Assist UM Leadership with documenting situations, performance evaluations, and timecards when necessary.
Assists meetings as needed.
Performs other duties as assigned.

Requirements:

High school graduate or equivalency.
Ability to communicate effectively with patients, family members, vendors and providers.
Working knowledge of Word, Excel, PowerPoint, EZ-Cap, Medic, and Report Riter.
Must have excellent communication skills both verbally and written.
Ability to handle a multitude of assignments, meeting all given deadlines.
Knowledge of correct punctuation, grammar and spelling.
Ability to deal responsibly with matters of a confidential matter.
Ability to prioritize work in order to meet daily deadlines.
Ability to work in a multi-task, high productive environment.
Ability to supervise staff with varying job responsibilities and assignments.
Ability to analyze routine statistical reports and communicate outcomes to supervisor and/or leadership as needed or assigned.
Knowledge of inventory control and supply ordering.
Understanding of current state and federal regulations pertaining to managed care delivery system.

The pay range for this position at commencement of employment is expected to be between $27.00 and $37.18/hr, non-exempt; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

Compensation: $ 25.19-$34.66 per hour

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Refine Your Search

utilization management jobs in lancaster, ca

Utilization Management Lead

Acute Case Manager

Regional Office Manager

Program Coordinator

Case Manager

LVN Case Manager - Inpatient

Clinical Care Manager - CA

Mental Health Therapist- Teen Residential Treatment

MENTAL HEALTH PROGRAM MANAGER I / EMERGENCY APPOINTMENTS HOMELESSNESS

CONTRACT PROGRAM AUDITOR / EMERGENCY APPOINTMENT HOMELESSNESS

MENTAL HEALTH PROGRAM MANAGER II / EMERGENCY APPOINTMENTS HOMELESSNESS

Counselor I

Care Advocate - Care Delivery

Counselor II

Counselor IV

Program Coordinator/Clinical Supervisor

Clinic Supervisor- East Hollywood

Registered Nurse Surgery Center Per Diem

Field Registered Nurse - Home Health - Per Diem/Days - Req# 2117935698

PSYCHIATRIC SOCIAL WORKER II

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