- Dignity Health (Sacramento, CA)
- **Job Summary and Responsibilities** The ** Utilization Review RN** is responsible for the review of medical records for appropriate admission status and ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- Cognizant (Sacramento, CA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Centene Corporation (Sacramento, CA)
- …INTENSIVE OUTPATIENT,** **PARTIAL HOSPITALIZATION** **AS WELL AS ECT TREATMENTS, AND UTILIZATION REVIEW NOTIFICATIONS FOR APPROVALS AND DENIALS** **.** **ACTIVE, ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Centene Corporation (Sacramento, CA)
- …perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical 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… more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support ... communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments… more
- Sharecare (Sacramento, CA)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Highmark Health (Sacramento, CA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Sutter Health (Sacramento, CA)
- …Responsible for validating and redesigning work flow and clinical content review for all clinical areas. Develops and maintains interdisciplinary teams to ... Health's clinical information systems. Provides focused attention and direction in the utilization of data from clinical information systems to develop metrics to… more
- Molina Healthcare (Sacramento, CA)
- …an intensive care unit (ICU) or emergency room. Previous experience in Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Sacramento, CA)
- …care unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Sacramento, CA)
- California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 NIGHT SHIFT 7:30PM - 08:30AM PACIFIC HOURS NON EXEMPT, 3 days a week will ... **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Sacramento, CA)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the… more
- Highmark Health (Sacramento, CA)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Datavant (Sacramento, CA)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… more
- Amergis (Sacramento, CA)
- …+ Minimum 1 year of acute/inpatient case management experience + Prior utilization review experience required Certifications: + Active California RN License ... Registered Nurse Case Manager - Utilization Management + Location: Sacramento, CA + Start Date: ASAP + Assignment Length: 13 Weeks + Openings: 1 + Weekly Pay:… more
- Dignity Health (Rancho Cordova, CA)
- …efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality ... and best practice in medical necessity determination and concurrent review . This position will supervise the department in an...of Nursing degree. - Clear and current CA Registered Nurse (RN) license. - Comprehensive knowledge of care management… more
- Dignity Health (Carmichael, CA)
- …efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality ... **Job Summary and Responsibilities** ** Nurse Manager of Care Coordination / Case Management**...Case Management** **Sign On / Relocation Options** As our ** Nurse Manager Care Coordination Manager at Mercy San Juan… more
- Sutter Health (Sacramento, CA)
- …in Healthcare (MPH, MHA, MS, MBA, etc.) **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California OR MD-Medical Doctor OR DO-Doctor of Osteopathy OR Foreign ... transition, including potential impact on data quality for prospective payments, utilization , and reimbursement. Knowledge of ICD-10 desirable. + Strong Organization… more
- Sutter Health (Roseville, CA)
- …and assists in meeting financial targets by effectively managing utilization , productivity, personnel and supplies. Participates as necessary in referral ... an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California + BLS-Basic Life Support Healthcare Provider **DEPARTMENT… more