- Evolent (Sacramento, CA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a...you ready to make a meaningful impact on patient care in a non- clinical setting? Join our… more
- Humana (Sacramento, CA)
- …Strategy: + Cultivate and maintain trusted relationships with CMOs and senior executive/ clinical leaders at provider and care delivery partner organizations. ... of care drivers. + Championing condition-based interventions. + Leading clinical strategies to manage unique populations, such as unattributed membership, low… more
- Genesis Healthcare (Elk Grove, CA)
- …therapists, consideration of clinical requirements and recommendations from the Regional Clinical Director. 8. Continues direct patient care . 9. Assists the ... department, including oversight related to case management, quality improvement, care planning, clinical utilization, and patient identification is… 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 ... A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience +… 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 ... + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management… more
- CVS Health (Sacramento, CA)
- …self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures ... needs to ensure appropriate administration of benefits. + Applies clinical judgment to the incorporation of strategies designed to...as experience with transferring patients to lower levels of care . + 1+ years' experience in Utilization Review… more
- Insight Global (Fremont, CA)
- …regarding their appointment. - Orders, unpacks, logs and stores supplies. - Assisting with clinical care , such as but not limited to: checking in patients, ... schedules and completing any pre-visit workflows. - Organizes and processes clinical specimens accurately. Identifies worksheet, computer and specimen problems and… more
- HCA Healthcare (Thousand Oaks, CA)
- …Summary: The Wound Care (WC) Nurse, under general supervision, coordinates the clinical functions of the Wound Care Center. Working autonomously, the WC ... and best practices. While overseeing the delivery of patient care , the WC Nurse will adhere to clinical...compelling, we encourage you to apply for our Wound Care RN opening. We promptly review all… more
- Cedars-Sinai (Beverly Hills, CA)
- …resolution. + Participates in quality assurance programs, conducts regular audits of clinical practices and patient care processes. Provides assistance in QA ... **Department** : Urology - La Cienega **Business Entity** : Cedars-Sinai Medical Care Foundation **Job Category** : Clinical Operations **Job Specialty** :… more
- Elevance Health (Los Angeles, CA)
- … management or case management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience; or any combination ... this position includes weekends. The Med Mgmt Nurse CA is responsible for review of the most complex or challenging cases that require nursing judgment, critical… more