- Humana (Sacramento, CA)
- …to make an impact** **Required Qualifications** + Registered nurse ( RN ) with unrestricted licensed **OR** independent licensed clinical social worker + ... part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds… more
- 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
- Humana (Sacramento, CA)
- …caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and independent ... established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge,...an impact** **Required Qualifications** + Compact licensure + Licensed Registered Nurse ( RN ) in the… 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
- Matrix Providers (Fairfield, CA)
- Registered Nurse - Disease Management Location: Fairfield, CA, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... and fair, reliable schedules. Matrix Providers is hiring a Registered Nurse - Disease Management ...identification, adoption, implementation and utilization of standardized clinical practice guidelines and protocols for management … 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
- 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... care is being provided. **Preferred** + Certification in utilization management or a related field +… 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 ... Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Dignity Health (Rancho Cordova, CA)
- …to collaborate with members of NSSA Regional Health Services Research (HSR), Utilization Management , Quality Management and various other departments, ... incumbent in this position supports the design, implementation and maintenance of clinical quality and outcome analytical systems for Mercy Healthcare. This position… 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
- 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 ... the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of… more
- Amergis (Rancho Cordova, CA)
- … clinical experience is required. Three to five years Utilization Management experiencerequired. One to three years charge/lead/supervisory/ management ... Salary: $1760 / Week Supervisor Utilization Management PriorAuthorization Anticipated Duration: ASAP...as well as improving patient experience. Minimum Requirements: + Registered Nurse or Licensed Practical Nursing license… 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 ... to those candidates with Home Health experience. 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 (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
- CommonSpirit Health (Rancho Cordova, CA)
- …responsibilities leading up to or including supervisory role + Experience in Utilization Management , Case Management or Care Coordination, Managed ... verbal and electronic communication stills, including professional telephone and email etiquette + RN with 3-years of clinical experience, one to include acute… more
- Highmark Health (Sacramento, CA)
- …Health **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
- Dignity Health (Stockton, CA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... with 1 year of relevant experience.** **Position Summary:** The RN Care Coordinator is responsible for overseeing the progression...clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year… more