- Cognizant (Sacramento, CA)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Sacramento, CA)
- …we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- CVS Health (Sacramento, CA)
- …Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization . **Required Qualifications** + Registered Nurse (RN) ... CVS Health Aetna has an opportunity for a full-time Utilization Management (UM) Nurse Consultant. As a...Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills… more
- CVS Health (Sacramento, CA)
- …good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- CVS Health (Sacramento, CA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Centene Corporation (Sacramento, CA)
- …preferred. 25% Travel CA RN License Required **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- CVS Health (Sacramento, CA)
- …Service/Health Services (as applicable to hiring program) or Associates degree with a Registered Nurse with Behavioral Health experience/ background with 3 years ... we do it all with heart, each and every day. **Position Summary** Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization… more
- Evolent (Sacramento, CA)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... 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… more
- Sutter Health (Sacramento, CA)
- …+ Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN- Registered Nurse of California Upon Hire **PREFERRED EXPERIENCE AS TYPICALLY ... SHSO-Sutter Health System Office-Valley **Position Overview:** This position facilitates utilization management (UM) processes to support that the right care… more
- Sharecare (Sacramento, CA)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- Sutter Health (Sacramento, CA)
- …Care Administration, or clinical related field **CERTIFICATION & LICENSURE:** + RN- Registered Nurse of California **TYPICAL EXPERIENCE:** + 8 years recent ... information systems. Provides focused attention and direction in the utilization of data from clinical information systems...direction in the utilization of data from clinical information systems to develop metrics to improve and… more
- Sutter Health (Sacramento, CA)
- …Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN- Registered Nurse of California + BLS-Basic Life Support Healthcare Provider ... distributions, and assists in meeting financial targets by effectively managing utilization , productivity, personnel, and supplies. Supports and educates staff in… more
- Sutter Health (Sacramento, CA)
- …nursing. **CERTIFICATION & LICENSURE:** + BLS-Basic Life Support Healthcare Provider + RN- Registered Nurse of California **TYPICAL EXPERIENCE:** + 5 years recent ... maintaining high standards of quality and patient safety within this specialized clinical setting. Provides leadership for Clinical Education, overseeing staff… 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 the ... performance reviews* Responsible to ensure that there is a nurse on call after hours for all homes (and...submit to State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least… 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 in ... 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… more
- Sutter Health (Sacramento, CA)
- …Graduate of an accredited School of Nursing **CERTIFICATION & LICENSURE:** + RN- Registered Nurse of California + BLS-Basic Life Support Healthcare Provider ... established plan of patient care and ensuring effective management of visit utilization and control of expenses. May assist in agency wide orientation, competency… more
- Sutter Health (Sacramento, CA)
- …**CERTIFICATION & LICENSURE:** + BLS-Basic Life Support Healthcare Provider + RN- Registered Nurse of California + Department: SOPS, ACLS-Advanced Cardiac ... manages capital and operational budgets to achieve financial targets via effective utilization of personnel, resources and supplies. Develops and maintains a solid… more