Utilization Review Manager - Home Care jobs in California

Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)

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Utilization Review and Clinical Care Manager - Behavioral Health
  • Health Plan of San Mateo
  • South San Francisco, CA FULL_TIME
  • We’re a local non-profit County Organized Health System (COHS) dedicated to the health of more than 160,000 low-income residents of San Mateo County, including all of its Medi-Cal beneficiaries. We believe that healthy is for everyone and need passionate, caring employees who share our passion to join us.

    As Utilization Review & Clinical Case Manager, you'll ensure seamless care for members, focusing on Mental Health & Substance Use Treatment. Responsibilities include assessments, care plans, coordination, leading meetings, referrals, and communication facilitation. Adherence to standards & quality improvement is essential.
    Position overview
    • Coordinate an interdisciplinary approach to ensure the continuity of care, providing utilization management, transfer coordination, discharge planning, and authorizations for covered services.
    • Conduct comprehensive assessments and develop individualized care plans based on assessment information.
    • Coordinate services with other departments, providers, programs, and community partners to provide necessary support.
    • Lead and participate in clinical huddles and interdisciplinary care team meetings with internal HPSM staff and external partners and providers.
    • Make referrals to various HPSM departments, community-based organizations, and governmental agencies when appropriate.
    • Promote clear communication amongst the care team, including family and community supports, and treating providers.
    • Teach appropriate interventions, link to resources, educate about benefits, and discuss medication effects and side effects as needed.
    • Adhere to case management practice standards and participate in continuous quality improvement efforts.
    Requirements
    These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.
    Education and experience
    • Licensed Master's degree in Psychology, Social Work, Counseling, or Marriage/Family Counseling, BCBA, or Licensed Ph.D. with 2 or more years of behavioral/mental health experience.
    • Three (3) years of managed care experience, preferably in Care Coordination or working with the health needs of the population served.
    • Certification as Certified Case Manager (CCM) preferred.
    • Bilingual in Spanish.
    Knowledge of:
    • Case management principles and practices.
    • Behavioral health programs, services, and healthcare public policy issues.
    • Advanced knowledge of community resources and social determinants of health.
    • HIPAA and other applicable federal and state regulations for confidentiality.
    Skills:
    • Strong interpersonal, conflict resolution, assertiveness, and collaboration skills.
    • Excellent written, verbal, and listening communication skills.
    Salary and benefits
    The starting salary range is $43.05-$57.05, depending on the candidate’s work experience.

    Excellent benefits package includes:
    • HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
    • Fully paid life, AD&D and LTD insurance
    • Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
    • 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
    • Tuition reimbursement plan
    • Employee wellness program
    It is HPSM's policy to provide equal employment opportunity for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.
  • Just Posted

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Utilization Review Case Manager
  • Torrance Memorial Medical Center
  • Torrance, CA FULL_TIME
  • Under general supervision, the Utilization Review Case Manager (UR CM) performs review of patient referral and medical record for appropriateness for Skilled Home Health services. The UR CM validates ...
  • 1 Month Ago

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RN Case Manager - Utilization Review
  • Prime Healthcare
  • Lynwood, CA FULL_TIME
  • Overview Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! St. Francis Medical Center, a member of Prime Healthcare, offers incre...
  • 20 Days Ago

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RN Case Manager/Utilization Review
  • Vitana Inc
  • Woodland, CA CONTRACTOR,TEMPORARY
  • Weekly pay includes taxable wage and per diems (non taxable stipend) if eligible Requirements: RN License for CA state, BLS certified by AHA and Co-vid Vaccination Card. 2 years experience as RN Case ...
  • Just Posted

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Interim Utilization Review RN Manager
  • FirstChoice
  • Fresno, CA CONTRACTOR,TEMPORARY,FULL_TIME
  • Are you an Acute Care Utilization Review RN Manager seeking your next adventure? Duration: 13-week Assignment This key leadership role, is responsible for management, leadership, and coordination of t...
  • 5 Days Ago

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RN Case Manager - Utilization Review
  • St. Francis Medical Center
  • Lynwood, CA FULL_TIME
  • Overview Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! St. Francis Medical Center, a member of Prime Healthcare, offers incre...
  • 1 Month Ago

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Director Utilization Management
  • AMI Network
  • San Diego, CA
  • I’m partnered with a major health plan in San Diego to find a Director of Utilization Management! This top-rated Medicai...
  • 3/28/2024 12:00:00 AM

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Utilities Manager
  • City of Upland, CA
  • Upland, CA
  • Salary : $124,287.53 - $158,625.88 Annually Location : Public Works - 1370 N. Benson Ave Upland, CA Job Type: Full Time ...
  • 3/28/2024 12:00:00 AM

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Utilities Manager (At-Will)
  • City of Rialto, CA
  • Rialto, CA
  • Salary : $116,448.00 - $156,060.00 Annually Location : Rialto, CA Job Type: Full-Time Job Number: 23-072 Department: RUA...
  • 3/28/2024 12:00:00 AM

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Maintenance and Utilities Manager
  • The Judge Group
  • Somerset, NJ
  • Do you love candy and snacks? Are you looking to join an ever evolving and rapidly growing team? PIM Brands might just b...
  • 3/28/2024 12:00:00 AM

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Utilization Management Assistant
  • Trinity Health
  • Des Moines, IA
  • Employment Type: Full timeShift: Description: GENERAL SUMMARY: Under general supervision, the Utilization Management Ass...
  • 3/28/2024 12:00:00 AM

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Utility Manager
  • Prairie Band Potawatomi Nation
  • Mayetta, KS
  • Tier: 2 Department: Administration Supervisor: General Manager of Operations Location: 16281 Q Road, Mayetta KS 66509 Pa...
  • 3/25/2024 12:00:00 AM

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Utility Management Consultant
  • HDR, Inc.
  • Charlotte, NC
  • Qualifications and Experience * BS in Civil or Environmental Engineering or a related technical discipline required. * M...
  • 3/25/2024 12:00:00 AM

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Utilization Management Coordinator
  • Hackensack Meridian Health
  • Point Pleasant Beach, NJ
  • Description: Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients ...
  • 3/25/2024 12:00:00 AM

California is a state in the Pacific Region of the United States. With 39.6 million residents, California is the most populous U.S. state and the third-largest by area. The state capital is Sacramento. The Greater Los Angeles Area and the San Francisco Bay Area are the nation's second and fifth most populous urban regions, with 18.7 million and 9.7 million residents respectively. Los Angeles is California's most populous city, and the country's second most populous, after New York City. California also has the nation's most populous county, Los Angeles County, and its largest county by area, S...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$83,870 to $106,929