- Centene Corporation (Sacramento, CA)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare… more
- Dignity Health (Rancho Cordova, CA)
- …Three (3) years acute care or related experience, including experience in case management, utilization review or discharge planning. - Clear and current CA RN ... for monitoring Dignity Health Medical Foundation inpatient admissions and concurrent review for appropriate level of care and medical necessity using InterQual… more
- ERP International (Mcclellan, CA)
- **Overview** ERP International is seeking a ** Registered Nurse ( RN ) Case Manager** for a full-time position supporting the **McClellan VA Medical Center** ... Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health… more
- Universal Health Services (Sacramento, CA)
- Responsibilities Sierra Vista Hospital is seeking a full-time Utilization Management Coordinator (MSW, MFT, MA, RN ) for the Utilization Management ... expertise to those suffering from emotional, behavioral and addiction problems. The Utilization Management Coordinator (MSW, MFT, MA, RN ) is responsible for… more
- Marriott (Sacramento, CA)
- …Information** Nurse CARE Manager (CARE - Coordinated Action and Response) Registered Nurse license required **Job Number** 24069165 **Job Category** Finance ... losses. The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if...informed **Education or Certification** + Must be a licensed registered nurse + Certification as an occupational… more
- Actalent (Sacramento, CA)
- …Acute care + Concurrent review + Home health + Health plan + Utilization review + Utilization management + Interqual Additional Skills & Qualifications: ... recognized sources such as NCCN and ACOG. + The successful RN candidate will review both inpatient and outpatient Medicare member appeals for benefits, medical… more
- Dignity Health (Rancho Cordova, CA)
- …skills. - Graduate of an accredited school of nursing. - Clear and current CA Registered Nurse ( RN ) license. **Preferred Qualifications:** - 7 years UM ... guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable for coordination of services for… more
- Lincoln Financial Group (Sacramento, CA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- CenterWell (Sacramento, CA)
- …+ Monitor the following key functions: + Program evaluation + Risk Management + Utilization Review + Patient Care Evaluation + Policies and procedures + Human ... supervisor. Required Qualifications + Graduate of an accredited school of nursing and current RN state license in good standing OR a graduate of an accredited school… more
- BrightSpring Health Services (Sacramento, CA)
- …Education: Degree from an accredited school of nursing Qualifications:* Must be a Licensed Registered Nurse ( RN ) in good standing and currently licensed by ... performance reviews* Responsible to ensure that there is a nurse on call after hours for all homes (and...State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least monthly to… more
- Elevance Health (Sacramento, CA)
- **Wound Care UM RN ** **Location:** Remote, within 50 miles of a pulse point **Hours:** An 8 hour shift Monday - Friday between the hours of 8 am - 7 pm CST. A proud ... of care for the people we serve. The **Wound Care UM RN ** is responsible for performing pre-certification certification and/or authorization activities for Home… more
- Centene Corporation (Sacramento, CA)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA… more
- Elevance Health (Sacramento, CA)
- ** Nurse Reviewer I** **Location: The ideal candidate for this role will live in one of the following states:** + California + Washington + Nevada **Shift** : An ... from 9:30 am - 6 pm **P** **ST** The ** Nurse Reviewer I** is responsible for conducting preauthorization, out...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… more
- Elevance Health (Sacramento, CA)
- ** Nurse Reviewer I** **Location:** Within 50 miles of a pulse point in the following states: + California + Colorado + Nevada + Tennessee **Shift** : Tuesday - ... Saturday, 10:30 am - 7:00 pm **C** **ST** The ** Nurse Reviewer I** is responsible for conducting preauthorization, out...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… more