Top 31 Utilization review Jobs in Patterson, Ca

ECM Case Specialist
Livingston Community Health —Livingston, CA
- $24.93 - $28.66 an hour
- Extended hours
- Spanish
- Hospital
- Writing skills
7d
Care Manager II, Acute
Sutter Health —Modesto, CA
- $82.48 - $115.46 an hour
- Part-time
- Acute care
- Nursing
- RN License
Supervisor, Acute Case Management
Sutter Health —Modesto, CA
- $142,105.60 - $213,158.40 a year
- Weekends as needed
- Nursing
- 5 years
- Word processing
Registered Nurse Case Manager (RN)
Doctors Hospital of Manteca —Manteca, CA
- Full-time
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
Medical Management Nurse
AllCare IPA —Modesto, CA
- From $50 an hour
- Full-time
- RN License
- Mid-level
- In-person
- Health insurance
- Dental insurance
Quick Apply
9d
Registered Nurse
Caring Hand Home Health Solutions, Inc. —Patterson, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Care Progression Physician Advisor, Sutter Memorial Medical Center
Sutter Health —Modesto, CA
- $242,112.00 - $387,379.20 a year
- Weekends as needed
- Medicine
- Hospital
- Customer service
MDS CONSULTANT RN
KALESTA HEALTHCARE GROUP —Modesto, CA
- $160,000 - $185,000 a year
- Full-time
- Skilled nursing facility
- Up to 50% travel
- RN License
Quick Apply
Bilingual Licensed Vocational Nurse (LVN) - Merced
LA FAMILIA —Turlock, CA
- $37.50 an hour
- Full-time
- Hybrid work
- Spanish
- Google Workspace
- Nursing
- Paid holidays
- Health insurance
Quick Apply
Primary Care Physician, PCP - Stanislaus PHF
Telecare Corporation —Ceres, CA
- $150 an hour
- Part-time
- 18 years or older
- CPR Certification
- Medicine
Quick Apply
Chief Medical Officer
SAN JOAQUIN COUNTY HEALTH COMMISSION —Modesto, CA
- $395,000 - $530,000 a year
- Remote
- Medicine
- Customer service
- 5 years
- AD&D insurance
- Paid holidays
Quick Apply
Physician - Primary Care Clinic
Community Health Centers of America —Gustine, CA
- $300,000 - $350,000 a year
- Part-time
- Medicine
- Management
- Writing skills
- Relocation assistance
- Health insurance
Quick Apply
Nurse Practitioner - Pulmonology
California Practice Staff —Modesto, CA
- Full-time
- Nursing
- RN License
- HIPAA
Nurse Practitioner/Physician Assistant - Urology - Modesto, CA
California Practice Staff —Modesto, CA
- Full-time
- CPR Certification
- Nursing
- BLS Certification
Physician - Pediatrics for Primary Care Clinic
Community Health Centers of America —Livingston, CA
- $280,000 - $300,000 a year
- Part-time
- Medicine
- Management
- Writing skills
- Relocation assistance
- Health insurance
Quick Apply
Physical Therapist PT-Full-Time
Garden City Healthcare Center —Modesto, CA
- $55 - $60 an hour
- Full-time
- Skilled nursing facility
- Management
- Doctoral degree
Quick Apply
Clinic Physician - Gastroenterologist
Community Health Centers of America —Livingston, CA
- $250,000 - $350,000 a year
- Full-time
- Medicine
- Writing skills
- BLS Certification
- Relocation assistance
- Health insurance
Quick Apply
Clinic Physician - Endocrinologist
Community Health Centers of America —Livingston, CA
- $250,000 - $350,000 a year
- Full-time
- Medicine
- Writing skills
- BLS Certification
- Relocation assistance
- Health insurance
Quick Apply
Nurse Practitioner
Pacific Care Salida —Modesto, CA
- From $150,000 a year
- Full-time
- Anatomy knowledge
- Urgent Care
- HIPAA
Quick Apply
1d
Occupational Therapist-OT Full-Time
Garden City Healthcare Center —Modesto, CA
- $55 - $60 an hour
- Full-time
- Skilled nursing facility
- Doctoral degree
- Mid-level
Quick Apply

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utilization review jobs near patterson, ca

ECM Case Specialist

Livingston Community Health -
Livingston, CA

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Job Details

Full-time
$24.93 - $28.66 an hour
7 days ago

Qualifications

Customer communication
BLS Certification
Driver's License
Bachelor's degree
Driving

Full Job Description

Position Overview

A successful ECM Case Specialist must be passionate about healthcare and want to make a difference in the lives of others while acting as a mission-driven catalyst to help LCH deliver the best quality of care and excellent service to our patients and their families.

The ECM Case Specialist works collaboratively with a multi-disciplinary team to develop and deliver clinical services that extend care beyond inpatient settings or traditional specialist office visits. This
role plans and implements medical and social service programs, promotes care coordination and continuity, and supports quality management for ECM members. The Case Specialist also serves as a key liaison between home health staff, providers, and members to ensure seamless access to services.

Essential Functions, Duties, and Responsibilities

Care Coordination and Case Management

Coordinate care for ECM-enrolled members with complex medical, behavioral health, and social needs.
Develop, implement, and monitor individualized care plans in collaboration with the interdisciplinary care team.
Facilitate communication among primary care providers, specialists, behavioral health providers, hospitals, health plans, and community agencies.
Assist members in scheduling and attending medical appointments.
Conduct outreach activities to engage eligible members in ECM services.
Establish and maintain therapeutic, professional relationships with members and families.
Utilize motivational interviewing and trauma-informed approaches to encourage participation in care.
Maintain regular contact with members through in-person, telephonic, and electronic communication methods.
Assess member needs related to housing, food insecurity, transportation, behavioral health, substance use treatment, employment, and other social determinants of health.
Identify barriers to care and develop strategies to address them.
Connect members with community resources, public benefits, and supportive services.
Assist members with applications and referrals for social service programs when appropriate.
Maintain accurate, timely, and complete case records in electronic health records (EHR) and case management systems.
Document member interactions, assessments, care plans, referrals, and outcomes in accordance with organizational and regulatory requirements.
Track member progress toward established goals and report outcomes as required.
Participate in case conferences, care team meetings, and utilization review discussions.
Collaborate with physicians, nurses, behavioral health providers, community health workers, and social service agencies.
Communicate significant changes in member condition, risk factors, or service needs to appropriate team members.
Conduct field visits, home visits, hospital visits, shelter visits, or community-based encounters as necessary.
Accompany members to appointments or service agencies when appropriate.
Maintain awareness of local community resources and referral networks.
Ensure compliance with HIPAA, Medi-Cal, health plan requirements, and organizational policies.
Adhere to ECM program requirements established by the California Department of Health Care Services and managed care plans.

Operational Support

Supports the overall needs of the organization by working flexible or extended hours when necessary.
Demonstrates competence with the mission, vision, and values of the organization in providing quality services to the community.
Other work-related duties as assigned. Duties and responsibilities may be added, deleted, or changed at any time at the direction of leadership, formally or informally, either verbally or in writing.
Maintains confidentiality and respect for all sensitive information.
Displays a positive, professional, and respectful demeanor at all times towards employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for LCH.
Contributes as part of the operations team by promoting positive staff interactions and maintaining open communication with other programs and departments.
Attends and actively participates in all meetings (e.g., department meetings, program meetings, staff meetings) and other activities as required or assigned

Education, Knowledge, Skills, and Abilities

Education and Experience

A bachelor's degree in human services, healthcare, or a social services-related field. Four+ years of demonstrated experience in care coordination. A combination of education and experience will be considered.
Experience at an FQHC or community health setting preferred

Certification/License

Obtain and maintain a Community Health Worker (CHW) certification within 12 months of hire. Current CHW certification is preferred.
Basic Life Support (BLS) Certification from the AHA.
Valid Driver's License.

Knowledge, Skills, and Abilities

Bilingual in English and one of the following is preferred: Spanish, Punjabi, or Portuguese.
Ability and willingness to drive and conduct field visits.
Knowledge of case management principles and care coordination practices.
Knowledge of Medi-Cal, ECM, Community Supports, and social service systems.
Strong communication, interpersonal, and organizational skills.
Ability to maintain confidentiality and professional boundaries.
Ability to work independently while managing multiple priorities.
Proficiency in electronic health records (EHR) and Microsoft Office applications.
Patient rights and confidentiality requirements.
Cultural competency and diversity awareness in healthcare.
Effective communication (verbal and written with patients, families, and staff).
Customer service / patient service oriented.
Time management and prioritization.
Attention to detail and accuracy.
Team collaboration.
Documentation and recordkeeping.
Adapt to changing priorities and workflows.
Demonstrate empathy and compassion toward patients.
Demonstrate reliability and accountability

Apply Now

Refine Your Search

utilization review jobs in patterson, ca

ECM Case Specialist

Care Manager II, Acute

Supervisor, Acute Case Management

Registered Nurse Case Manager (RN)

Medical Management Nurse

Registered Nurse

Care Progression Physician Advisor, Sutter Memorial Medical Center

MDS CONSULTANT RN

Bilingual Licensed Vocational Nurse (LVN) - Merced

Primary Care Physician, PCP - Stanislaus PHF

Chief Medical Officer

Physician - Primary Care Clinic

Nurse Practitioner - Pulmonology

Nurse Practitioner/Physician Assistant - Urology - Modesto, CA

Physician - Pediatrics for Primary Care Clinic

Physical Therapist PT-Full-Time

Clinic Physician - Gastroenterologist

Clinic Physician - Endocrinologist

Nurse Practitioner

Occupational Therapist-OT Full-Time

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