- Alameda Health System (Oakland, CA)
- Clinical Nurse V + Oakland, CA + Highland General Hospital...MCH/OB Clinic (K6) + Full Time - Day + Management + $64.00- $96.00 + Req #:42878-31844 + FTE:1 + ... nursing unit for which responsible. Promotes effective and economic utilization of personnel and supplies. Monitors utilization ...Three years full time continuous experience as a Clinical Nurse III with AHS. (2) Two years of full-time… more
- Alameda Health System (Oakland, CA)
- Clinical Nurse IV + Oakland, CA + Highland General Hospital + Emergency + Full Time - Night + Management + TBD + Req #:43134-32050 + FTE:1 + Posted:November 4, ... the organizational structure of a unit which promotes effective and economic utilization of personnel and supplies; assures availability and operability of supplies… more
- Alameda Health System (Oakland, CA)
- …+ Highland General Hospital + FQ MCH/OB Clinic (K6) + Full Time - Day + Management + $85.55 - $142.40/ Hour + Req #:42908-31868 + FTE:1 + Posted:October 15, 2025 ... of the designated service line including business development, personnel management , fiscal management , strategic planning, physician recruitment plan,… more
- CenterWell (Sacramento, CA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- CVS Health (Sacramento, CA)
- …experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult… more
- Centene Corporation (Sacramento, CA)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- CVS Health (Sacramento, CA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Molina Healthcare (Oakland, CA)
- …post-discharge coordination to reduce hospital readmission rates and emergency room utilization . * Performs face-to-face in-person visits in a variety of settings ... states besides home state based on business need. * Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and… 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 ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (Sacramento, CA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Elevance Health (Walnut Creek, CA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Sign on Bonus: $5000.**...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …and treatment methods, with specific knowledge and skills in areas of risk management , infection control, and utilization review. + Current knowledge of ... and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Clinical Nurse Educator PAY RANGE: $135,200-$170,690 Annually REPORTS TO: Chief Nursing… more
- Sutter Health (Sacramento, CA)
- …distributions, and assists in meeting financial targets by effectively managing utilization , productivity, personnel, and supplies. Supports and educates staff in ... nursing. + **BSN** _Preferred_ **CERTIFICATION & LICENSURE:** + **RN** -Registered Nurse of California + **BLS** -Basic Life Support Healthcare Provider **DEPARTMENT… more
- Sutter Health (Sacramento, CA)
- …Health's clinical information systems. Provides focused attention and direction in the utilization of data from clinical information systems to develop metrics to ... Administration, or clinical related field **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California **TYPICAL EXPERIENCE:** + 8 years recent relevant… more
- Sutter Health (Berkeley, 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 Required. + BSN Preferred **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California + BLS-Basic Life Support Healthcare Provider + ACLS-Advanced… more
- Amergis (Sacramento, CA)
- Registered Nurse Case Manager - Utilization Management + Location: Sacramento, CA + Start Date: ASAP + Assignment Length: 13 Weeks + Openings: 1 + Weekly ... Monday - Friday Requirements: + Minimum 1 year of acute/inpatient case management experience + Prior utilization review experience required Certifications: +… more
- Molina Healthcare (Sacramento, CA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- CVS Health (Sacramento, CA)
- …with heart, each and every day. **Position Summary** As a Care Management Associate you will be supporting comprehensive coordination of medical services including ... and supporting the implementation of care plans to promote effective utilization of health services service. Promotes/supports quality effectiveness of Healthcare… more
- Molina Healthcare (Sacramento, CA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in...(ICU) or emergency room. Previous experience in Prior Auth, Utilization Review / Utilization Management … more
