- 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)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… more
- CenterWell (Sacramento, CA)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… 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 ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… more
- Molina Healthcare (Sacramento, CA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… 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)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Dignity Health (Sacramento, CA)
- …emphasis will be on care coordination, communication, and collaboration with utilization management , nursing, physicians, ancillary departments, insurers, and ... **Job Summary and Responsibilities** **Job Summary:** The RN Care Coordinator is responsible for overseeing the...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- Molina Healthcare (Sacramento, CA)
- …relevant education and experience or equivalent combination of relevant education and experience. * Registered Nurse ( RN ), * Ability to manage conflict and ... California Registered Nurse .** JOB DESCRIPTION Job Summary...in some or all of the following functions: care management , utilization management , behavioral health,… 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 ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Molina Healthcare (Sacramento, CA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 NIGHT SHIFT 7:30PM - 08:30AM PACIFIC...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required… more
- Elevance Health (Walnut Creek, CA)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... equivalent background. + Current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by...adapt to new technologies preferred. + Previous experience in utilization management with a broad range of… more
- Highmark Health (Sacramento, CA)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- 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 ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Sutter Health (Santa Rosa, CA)
- …**EDUCATION:** Graduate of an accredited School of Nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California BLS-Basic Life Support Healthcare ... at Home - Outer Bay **Position Overview:** 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
- Sutter Health (Oakland, CA)
- …an accredited school of nursing Required + BSN Preferred **CERTIFICATION & LICENSURE** + RN - Registered Nurse of California Required + Certified Case Manager ... acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the… more
- Amergis (Fairfield, CA)
- …Requirements: + Active CA RN License + Minimum 2 years of Case Management experience + Experience with EPIC EMR + BLS Certification ?? Why Fairfield, CA? ... The RN Case Manager is responsible for coordinating continuum...of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical… more
- Amergis (Fairfield, CA)
- …? Active California RN License ? Minimum 2 years of Case Management experience ? Strong clinical judgment and communication skills ? Ability to work some ... The RN Case Manager is responsible for coordinating continuum...of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical… more
- Amergis (Sacramento, CA)
- The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service ... and compliance with medical regime. Minimum Requirements: + Current RN licensure in state practicing + At least one...state practicing + At least one year of Case Management experience preferred + Current CPR if applicable +… more
- Alameda Health System (Oakland, CA)
- …in Nursing preferred. Required License/Certifications: CCRN - Critical Care Registered Nurse is desirable. Required Licenses/CertificationsTPM: ACLS, TNCC, ... HGH Endoscopy Svcs + Full Time - Day + Management + $64.00- $96.00 + Req #:42809-31789 + FTE:1...department). Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.… more