- Dignity Health (Carmichael, CA)
- **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The ** Utilization Review RN** is responsible for ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- Zurich NA (Sacramento, CA)
- AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position, offering ... flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead...of experience in the Nursing areaAND + Registered Professional Nurse license in residential area and in operational national/local… more
- Centene Corporation (Sacramento, CA)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- The Cigna Group (Sacramento, CA)
- …**Job Description Summary** Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate ... for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of… more
- Evolent (Sacramento, CA)
- …adjudication of processed appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN ... the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
- Sutter Health (Roseville, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of ... care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely… more
- Sharecare (Sacramento, CA)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… more
- Lincoln Financial (Sacramento, CA)
- …Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to work here?** At ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Evolent (Sacramento, CA)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Highmark Health (Sacramento, CA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Molina Healthcare (Sacramento, CA)
- **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 NIGHT SHIFT: 7:30PM - 08:30AM PACIFIC HOURS NON EXEMPT, 3 days a week will rotate._** **_TRAINING SCHEDULE ... Previous experience in Hospital Acute Care, ER or ICU, Inpatient/ Concurrent Review , Utilization Review / Utilization Management and knowledge of… more
- Centene Corporation (Sacramento, CA)
- …applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA ... of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical… more
- Dignity Health (Rancho Cordova, CA)
- …guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of services for ... Ensures UM Physicians are provided the relevant information needed to accurately review a referral. Fosters the relationship between the Pre-Authorization team and… more
- Dignity Health (Carmichael, CA)
- …efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality ... **Responsibilities** ** Nurse Manager of Care Coordination / Case Management**...Case Management** **Sign On / Relocation Options** As our ** Nurse Manager Care Coordination Manager at Mercy San Juan… more
- Sacramento Behavioral Healthcare Hospital (Sacramento, CA)
- …documentation of admissions to the Business Office, Admitting Unit and the Utilization Review Department. . Maintains knowledge of the developmental tasks ... CA Board of Behavioral Sciences (AMFT, ACSW, or APCC), or Registered Nurse . Current Cardiopulmonary Resuscitation (CPR) certification, or obtained during initial… more