- CVS Health (Sacramento, CA)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Sacramento, CA)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- CVS Health (Sacramento, CA)
- … (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all ... and state regulated turn-around times. This includes reviewing written clinical records. **Key Responsibilities of the UM Nurse...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Sacramento, CA)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Centene Corporation (Sacramento, CA)
- … Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- CVS Health (Sacramento, CA)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Evolent (Sacramento, CA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Sutter Health (Sacramento, CA)
- …SHSO-Sutter Health System Office-Valley **Position Overview:** This position facilitates utilization management (UM) processes to support that the ... Facility Acute Care Manager (CM). This position provides third-party payers clinical information to assure reimbursement; and coordinating care with the treatment… more
- Sharecare (Sacramento, CA)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (Sacramento, CA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Highmark Health (Sacramento, CA)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Sutter Health (Roseville, CA)
- …providers and community resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical and social situations ... care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely… more
- Sutter Health (Sacramento, CA)
- … clinical information systems. Provides focused attention and direction in the utilization of data from clinical information systems to develop metrics to ... or clinical related field **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California **TYPICAL EXPERIENCE:** + 8 years recent relevant experience.… more
- Evolent (Sacramento, CA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Elevance Health (Rancho Cordova, CA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Sign on Bonus: $5000.**...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Sutter Health (Sacramento, CA)
- …distributions, and assists in meeting financial targets by effectively managing utilization , productivity, personnel, and supplies. Supports and educates staff in ... an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California + BLS-Basic Life Support Healthcare Provider **DEPARTMENT… more
- Sutter Health (Sacramento, CA)
- …maintaining high standards of quality and patient safety within this specialized clinical setting. Provides leadership for Clinical Education, overseeing staff ... manages capital and operational budgets to achieve financial targets via effective utilization of personnel, resources and supplies. Develops and maintains a solid… more
- Molina Healthcare (Sacramento, CA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Highmark Health (Sacramento, CA)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, including review… more
- Sutter Health (Roseville, CA)
- …Sutter Health philosophies and initiatives. Participates as a member of the utilization Management Committee (UMC). **Job Shift:** Days **Schedule:** Full Time ... current Federal and State regulations and guidelines. Has frequent contact with Nurse Managers/ Directors, Risk and Ethics staff, Ancillary Services, Patient Access… more