- The Cigna Group (Sacramento, CA)
- …Other duties as required and related to this role. **Minimum requirements:** + Active unrestricted Registered Nurse ( RN ) license in state or territory of the ... to develop models and procedures, and monitor trends, within Nurse Case Management . RN and...Scope:** + Manages/Coordinates an active caseload of inpatient case management cases for Cigna. + Uses clinical … more
- CenterWell (Sacramento, CA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... the appropriate courses of action. The Utilization Management Nurse 2 uses clinical ...skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license ( RN )… more
- Sharecare (Sacramento, CA)
- …ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification ... the disease management program intervention guidelines. A Clinical Registered Nurse is supervised...or call campaigns. + Accepts warm transfer calls from non- RN colleagues for assessment and/or additional discussion with participant… more
- Sutter Health (Sacramento, CA)
- …+ Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** + ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN...resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical … more
- Actalent (Sacramento, CA)
- …Overview We are seeking an experienced and detail oriented. Registered Nurse ( RN ) to join our Utilization Management team. This role is ideal for ... Registered Nurse - Utilization Management PAY: $45 hourly...a clinically skilled RN with a strong experience in acute care and a passion for… more
- Sutter Health (Sacramento, CA)
- …MS in Nursing, Case management , or related field **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California + OR LCSW-Licensed Clinical ... SHSO-Population Health Services-Valley **Position Overview:** Manages the overall operations of Utilization Management department for Sutter Health Network in… more
- Molina Healthcare (Sacramento, CA)
- **HOSPICE OVERSIGHT CASE MANAGER ( REGISTERED NURSE )** California residents preferred** **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works ... Exceptional knowledge of California hospice facilities Working knowledge of Utilization Management processes **Preferred License, Certification, Association**… more
- Sutter Health (Sacramento, CA)
- …+ Other: Graduate of an accredited School of Nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California + BLS-Basic Life Support Healthcare ... Care at Home - Valley **Position Overview:** An experienced RN who is responsible for the overall management...the established plan of patient care and ensuring effective management of visit utilization and control of… more
- Dignity Health (Carmichael, CA)
- …emphasis will be on care coordination communication and collaboration with utilization management nursing physicians ancillary departments insurers and post ... **Responsibilities** **Varied day shift Per Diem RN Care Coordinator - start times: 0500 or...guidelines to ensure progression of care + Understanding how utilization management and case management … more
- Dignity Health (Woodland, CA)
- …effectively with multiple stakeholders + Professional communication skills. + Understand how utilization management and case management programs integrate. + ... striving to achieve high levels of patient satisfaction. The RN Care Coordinator consistently conducts the utilization ...clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year… more
- Molina Healthcare (Sacramento, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... with California providers **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current… more
- Molina Healthcare (Sacramento, CA)
- …Previous experience in Hospital Acute Care, ER or ICU, Inpatient/ Concurrent Review, Utilization Review / Utilization Management and knowledge of InterQual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
- Highmark Health (Sacramento, CA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective ** utilization management ** strategies including: review of appropriateness of health ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Evolent (Sacramento, CA)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... , you will be a key member of the utilization management team. We can offer you...appropriately. **Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in… more
- Humana (Sacramento, CA)
- …to make an impact** **REQUIRED QUALIFICATIONS:** + Registered nurse ( RN ) with unrestricted licensed **OR** independent licensed clinical social worker + ... 5+ years of previous clinical experience in utilization management + 2+ years of indirect or direct leadership experience + Comprehensive knowledge of… more
- Highmark Health (Sacramento, CA)
- …degree in Business or Clinical field **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse ( RN ) or Pharmacist (Pharm D) or Physician Assistant ... + Deep Clincal Expertise -extensive knowledge of clinical , quality, care, utilization , high-cost claim, and population health management . Must be a… more
- United Therapeutics (Sacramento, CA)
- …years of PAH nursing experience, including ICU and critical care of PAH patients + Registered Nurse ( RN ) - State Licensure and/or Compact State Licensure ... RN - Registered Nurse - State Licensure and/or Compact... clinical content + Demonstrated high competency in clinical management , conversations, patient management ,… more
- Centene Corporation (Sacramento, CA)
- …Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + For Health ... be the one who changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified,… more
- Molina Healthcare (Sacramento, CA)
- …Practical Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- Sedgwick (Sacramento, CA)
- …in establishing policy and procedures to assure compliance to best practices, clinical management services standards, state regulations, and client service ... efficient, cost effective, and high quality delivery of case management and utilization review services to clients...and to develop and deliver training. + Works with Clinical Operation Management regarding overall program strategy;… more