- 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 ... assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare… more
- Dignity Health (Rancho Cordova, CA)
- …Three (3) years acute care or related experience, including experience in case management, utilization review or discharge planning. - Clear and current CA RN ... for monitoring Dignity Health Medical Foundation inpatient admissions and concurrent review for appropriate level of care and medical necessity using InterQual… more
- Universal Health Services (Sacramento, CA)
- Responsibilities Sierra Vista Hospital is seeking a full-time Utilization Management Coordinator (MSW, MFT, MA, RN ) for the Utilization Management ... expertise to those suffering from emotional, behavioral and addiction problems. The Utilization Management Coordinator (MSW, MFT, MA, RN ) is responsible for… more
- Marriott (Sacramento, CA)
- …Information** Nurse CARE Manager (CARE - Coordinated Action and Response) Registered Nurse license required **Job Number** 24069165 **Job Category** Finance ... losses. The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if...informed **Education or Certification** + Must be a licensed registered nurse + Certification as an occupational… more
- Dignity Health (Folsom, CA)
- …of patient satisfaction. The RN Care Coordinator consistently conducts the utilization review process and the discharge planning process as required by ... the provision of care in accordance with and in compliance of the Dignity Health Utilization Review Policy. + Establishes and documents a working DRG on each… more
- Fresenius Medical Center (Sacramento, CA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Dignity Health (Woodland, CA)
- …of patient satisfaction. The RN Care Coordinator consistently conducts the utilization review process and the discharge planning process as required by ... candidate without the required experience may be considered. + Current CA Registered Nurse ( RN ) license. **Preferred Qualifications:** + BSN degree or… 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 ... guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable for coordination of services for… more
- Sutter Health (Sacramento, CA)
- …Other: Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California CLC-Certified Lactation Consultant OR ... EDUCATION PROGRAM DESIGN * Conducts educational needs assessments through data analysis, review of hospital utilization trends, literature review of… more
- Dignity Health (Rancho Cordova, CA)
- …position will involve rotating Saturday coverage.** **Position Summary:** The Manager of Utilization Management (UM) is responsible for managing the day to day ... operation of Utilization Management Department and Prior Authorization (PA) teams including hiring, scheduling, coaching, development and evaluation of employee… more
- CenterWell (Sacramento, CA)
- …+ Monitor the following key functions: + Program evaluation + Risk Management + Utilization Review + Patient Care Evaluation + Policies and procedures + Human ... supervisor. Required Qualifications + Graduate of an accredited school of nursing and current RN state license in good standing OR a graduate of an accredited school… more
- BrightSpring Health Services (Sacramento, CA)
- …Education: Degree from an accredited school of nursing Qualifications:* Must be a Licensed Registered Nurse ( RN ) in good standing and currently licensed by ... performance reviews* Responsible to ensure that there is a nurse on call after hours for all homes (and...State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least monthly to… more
- Sharecare, Inc. (Sacramento, CA)
- …support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... CT Monday- Thursday 8:00a-2:30p CT every 3rd Saturday The RN has the responsibility for supporting the goals and...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Elevance Health (Sacramento, CA)
- **Wound Care UM RN ** **Location:** Remote, within 50 miles of a pulse point **Hours:** An 8 hour shift Monday - Friday between the hours of 8 am - 7 pm CST. A proud ... of care for the people we serve. The **Wound Care UM RN ** is responsible for performing pre-certification certification and/or authorization activities for Home… 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 ... applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA… more
- Humana (Sacramento, CA)
- …projects. **Use your skills to make an impact** **Required Qualifications** + Licensed as a Registered Nurse in the State of Wisconsin or have a compact license. ... put health first** Humana is seeking a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare) team....the lives of others. **Essential Duties and Responsibilities:** + Review PA requests for home health services, durable medical… more
- Elevance Health (Sacramento, CA)
- ** Nurse Reviewer I** **Location:** Within 50 miles of a pulse point in the following states: + California + Colorado + Nevada + Tennessee **Shift** : An 8 hour shift ... of 7 am - 6 pm **C** **ST** The ** Nurse Reviewer I** is responsible for conducting preauthorization, out...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… more
- Sharecare, Inc. (Sacramento, CA)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... orientation and to take the pre and post-test to review competency during orientation. Yearly competency test is required...will follow company policy to transfer call to an RN or appropriate colleague when member needs are outside… more
- Elevance Health (Sacramento, CA)
- **Wellness Nurse Consultant** **Sign Bonus: $5000** At **Federal Health Products and Services - FHPS** , a proud member of the Elevance Health, Inc. family of ... 50 miles of a pulse point site listed above. The **Wellness Nurse Consultant** position is responsible for developing and recommending customized, group-specific… more
- Elevance Health (Sacramento, CA)
- …You Will Make an Impact:** + Conducts precertification, continued stay review , care coordination, or discharge planning for appropriateness of treatment setting ... Requires minimum of 3 years acute care clinical experience or case management, utilization management or managed care experience; or any combination of education and… more