- CenterWell (Sacramento, CA)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional… more
- CenterWell (Sacramento, CA)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience +… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... provide requested clinical and psychosocial information to assure reimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively… more
- Sutter Health (Goleta, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care , and observation status. + Working ... Santa Barbara **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's accepted… more
- LA Care Health Plan (Los Angeles, CA)
- …their authorized representative, the Ombudsman office, state contractors, member advocates, LA Care Board Members, providers, etc. The Manager is responsible for ... Manager , Customer Solution Center Appeals and Grievances Job...Review and monitor procedures for identifying quality of care issues and work collaboratively with multiple departments (Claims,… more
- Sharp HealthCare (San Diego, CA)
- …requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving care in ... level of care ; work closely with ambulatory care manager (ACM) at the system level,...provides information to the department head as indicated. + Utilization review and utilization managementThe… more
- Sutter Health (Roseville, CA)
- …case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care , and observation status. + Awareness ... experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside...to include the achievement of optimal health, access to care , and appropriate utilization of resources balanced… more
- Providence (Santa Rosa, CA)
- **Description** Care Manager RN - Case Management at Providence Santa Rosa Memorial Hospital in Santa Rosa, CA. This position is Per Diem and will work 8-hour ... with management, medical staff and medical center personnel. Provides payor/ utilization review organizations with concurrent retrospective utilization… more
- Sutter Health (Modesto, CA)
- …and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care , and observation status. Awareness ... experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside...to include the achievement of optimal health, access to care , and appropriate utilization of resources balanced… more
- LA Care Health Plan (Los Angeles, CA)
- …current and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager ... such as a health insurance environment and/or experience as care manager in home health or hospice...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager… more