- 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
- Cognizant (Sacramento, CA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Lincoln Financial (Sacramento, CA)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Centene Corporation (Sacramento, CA)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- CVS Health (Sacramento, CA)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Sharecare (Sacramento, CA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- ICW Group (Sacramento, CA)
- …AND SKILLS** Understanding of Workers' Compensation, Workers' Compensation Managed Care processes, Utilization Review, Telephonic Nurse Case Management , and ... **ESSENTIAL DUTIES AND RESPONSIBILITIES** Provides oversight for all vended Nurse Case Management (NCM) products, including Field... management issues related to bill review, case management and utilization review. + Works closely… more
- Veterans Affairs, Veterans Health Administration (Mcclellan, CA)
- …for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Administersmedications ... responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Administers… 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
- Sutter Health (Roseville, CA)
- …Administration **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's accepted ... necessity is met and at the appropriate level of care. Coordinates the utilization management , resource management , discharge planning, post-acute care… more
- Sutter Health (Roseville, CA)
- …care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely ... of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through… more
- Evolent (Sacramento, CA)
- …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 ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… 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
- Evolent (Sacramento, CA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Dignity Health (Rancho Cordova, CA)
- …Operations team with achieving and maintaining compliance with quality improvement, risk management , and utilization review strategies. **Skills for success in ... \#homehealthmanager, **Job Requirements** **Minimum:** + Minimum of two (2) years of management /leadership experience (within the last 5 years) in a home health… 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
- Highmark Health (Sacramento, CA)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… more
- Sutter Health (Roseville, CA)
- …Sutter Health philosophies and initiatives. Participates as a member of the utilization Management Committee (UMC). **Job Shift:** Days **Schedule:** Full Time ... current Federal and State regulations and guidelines. Has frequent contact with Nurse Managers/ Directors, Risk and Ethics staff, Ancillary Services, Patient Access… more
- Sacramento Behavioral Healthcare Hospital (Sacramento, CA)
- … management , group therapy, family & individual sessions. Psychiatrists, nurse practitioners, and internal medicine physicians comprise the provider group with ... rules, Joint Commission requirements, and legal regulations; participating in utilization reviews; and remaining available for emergency consultations. + Improves… more
- Sharecare (Sacramento, CA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more