- 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
- Molina Healthcare (Sacramento, CA)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... **California Registered Nurse . JOB DESCRIPTION Job Summary Leads and supervises...* Assists in implementing health management , care management , utilization management , behavioral health… 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 ... 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 rotate.… more
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Centene Corporation (Sacramento, CA)
- …experience with prior auth is highly preferred** **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… 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
- Dignity Health (Rancho Cordova, CA)
- …Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing utilization management (UM )services. The focus is to provide high quality, ... outcomes of patients. **Job Requirements** **Minimum Qualifications:** - 3 years Managed Care/ Utilization Management (UM) experience. - 5 years LVN experience. -… 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
- 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
- Elevance Health (Rancho Cordova, 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
- 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
- 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...emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management … more
- Dignity Health (Rancho Cordova, CA)
- …RN is responsible for providing telephonic clinical assessment, health education and utilization management services to a variety of patients. **Job ... triage nurse experience + Familiarity with an electronic practice management system **Where You'll Work** Dignity Health Medical Foundation, established in 1993,… more
