- The Cigna Group (Sacramento, CA)
- …Other duties as required and related to this role. **Minimum requirements:** + Active unrestricted Registered Nurse ( RN ) license in state or territory of the ... to develop models and procedures, and monitor trends, within Nurse Case Management . RN and...Scope:** + Manages/Coordinates an active caseload of inpatient case management cases for Cigna. + Uses clinical … more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure ... skills to make an impact** **Required Qualifications** + Active Registered Nurse license in a state that...one, (1), year of experience auditing and/or performing case management or utilization management chart… more
- Sharecare (Sacramento, CA)
- …ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification ... the disease management program intervention guidelines. A Clinical Registered Nurse is supervised...or call campaigns. + Accepts warm transfer calls from non- RN colleagues for assessment and/or additional discussion with participant… more
- CVS Health (Sacramento, CA)
- …care. - Perform medical necessity reviews. **Required Qualifications** - 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...in a hospital setting. - A Registered Nurse that holds an active, unrestricted… 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
- Sutter Health (Roseville, CA)
- …school of nursing + Bachelor's in Nursing preferred. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** + ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN...resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical … 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 ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers… more
- Dignity Health (Rocklin, CA)
- …responsible for providing telephonic clinical assessment, health education and utilization management services to a variety of patients. **Qualifications** ... **Responsibilities** The Contact Center Triage RN is responsible for knowing his/her professional scope...diploma or equivalent. + Satisfactory completion of a formal Registered Nurse program pursuant to the Division… more
- Dignity Health (Rancho Cordova, CA)
- …of nursing. - BS degree or experience equivalent required. - Clear and current CA Registered Nurse ( RN ) license. - Knowledge of all applicable federal and ... the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of… more
- Amergis (Rancho Cordova, CA)
- … clinical experience is required. Three to five years Utilization Management experiencerequired. One to three years charge/lead/supervisory/ management ... Salary: $1760 / Week Supervisor Utilization Management PriorAuthorization Anticipated Duration: ASAP...as well as improving patient experience. Minimum Requirements: + Registered Nurse or Licensed Practical Nursing license… more
- Molina Healthcare (Sacramento, CA)
- **HOSPICE OVERSIGHT CASE MANAGER ( REGISTERED NURSE )** California residents preferred** **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works ... Exceptional knowledge of California hospice facilities Working knowledge of Utilization Management processes **Preferred License, Certification, Association**… more
- Sutter Health (Roseville, CA)
- …+ Other: Graduate of an accredited School of Nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California + BLS-Basic Life Support Healthcare ... Care at Home - Valley **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
- Molina Healthcare (Sacramento, CA)
- …Previous experience in Hospital Acute Care, ER or ICU, Inpatient/ Concurrent Review, Utilization Review / Utilization Management and knowledge of InterQual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
- CommonSpirit Health (Rancho Cordova, CA)
- …responsibilities leading up to or including supervisory role + Experience in Utilization Management , Case Management or Care Coordination, Managed ... verbal and electronic communication stills, including professional telephone and email etiquette + RN with 3-years of clinical experience, one to include acute… more
- Highmark Health (Sacramento, CA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Evolent (Sacramento, CA)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... , you will be a key member of the utilization management team. We can offer you...appropriately. **Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in… more
- Highmark Health (Sacramento, CA)
- …degree in Business or Clinical field **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse ( RN ) or Pharmacist (Pharm D) or Physician Assistant ... + Deep Clincal Expertise -extensive knowledge of clinical , quality, care, utilization , high-cost claim, and population health management . Must be a… more
- Humana (Sacramento, CA)
- …(NCQA) standards **PREFERRED QUALIFICATIONS:** + Registered nurse ( RN ) with unrestricted licensed **OR** independent licensed clinical social worker ... + Bachelor's degree or equivalent experience + 5+ years of previous clinical experience in utilization management + 2+ years of indirect or direct leadership… more
- United Therapeutics (Sacramento, CA)
- …years of PAH nursing experience, including ICU and critical care of PAH patients + Registered Nurse ( RN ) - State Licensure and/or Compact State Licensure ... RN - Registered Nurse - State Licensure and/or Compact... clinical content + Demonstrated high competency in clinical management , conversations, patient management ,… more
- Centene Corporation (Sacramento, CA)
- …Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + For Health ... be 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