- Humana (Sacramento, CA)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (Sacramento, CA)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- The Cigna Group (Sacramento, CA)
- + **Job Description Summary** Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates ... to develop models and procedures, and monitor trends, within Nurse Case Management . RN and current unrestricted nursing license required. **Job Description**… more
- Matrix Providers (Fairfield, CA)
- …out projects with consideration for the goals and objectives of the MTF-s Utilization Management and Medical Management Departments. - Develops detailed ... Registered Nurse - Disease Management Location: Fairfield,...team and facility staff on policies and procedures for utilization of guidelines, protocols, and other disease management… more
- The Cigna Group (Sacramento, CA)
- …license in state where you reside. + 3 years' experience in case management or utilization review. **Preferred requirements:** + Bachelors/CCM preferred + ... 12-15 direct reports who are directly responsible for inpatient case management and all associated performance requirements for Cigna. + Interfaces with… 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 ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Molina Healthcare (Sacramento, CA)
- **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, ... are most receptive including home, nursing facilities, and "pop up" clinic. The Nurse Practitioner will be required to work primarily in non-clinical settings and… more
- Sutter Health (Sacramento, CA)
- …care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely ... of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through… more
- Centene Corporation (Sacramento, CA)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + RN -… more
- Sharecare (Sacramento, CA)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Highmark Health (Sacramento, CA)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … 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 ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Sutter Health (Auburn, CA)
- …**Organization:** SAFH-Sutter Auburn Faith Hospital **Position Overview:** The Registered Nurse in the Acute Care setting manages the patient/family experience ... through utilization of critical thinking, teamwork, effective communication, and nursing...accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN-Registered Nurse for the state where care is provided +… more
- Sutter Health (Roseville, CA)
- …manages capital and operational budgets to achieve financial targets via effective utilization of personnel, resources and supplies. Develops and maintains a solid ... of nursing. + **BSN** _preferred_ **CERTIFICATION & LICENSURE:** + **RN** -Registered Nurse of California + **BLS** -Basic Life Support Healthcare Provider **TYPICAL… more
- Sutter Health (Antioch, CA)
- …manages capital and operational budgets to achieve financial targets via effective utilization of personnel, resources and supplies. Develops and maintains a solid ... an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California + BLS-Basic Life Support Healthcare Provider **TYPICAL… more
- Sutter Health (Sacramento, CA)
- …SHSO-Population Health Services-Valley **Position Overview:** Manages the overall operations of Utilization Management department for Sutter Health Network in ... contact Medical Foundations, Medical Groups, IPAs, and with the Administrative Team, Nurse Executives and Directors, Risk Management & Ethics staff, Ancillary… more
- United Therapeutics (Sacramento, CA)
- …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… more
- Humana (Sacramento, CA)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- Dignity Health (Rancho Cordova, CA)
- …the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of ... sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management guidelines… more