- Dignity Health (Woodland, CA)
- …This position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilties may include: - ... CA, with occasional onsite meetings in Woodland.** **Position Summary:** The Utilization Review LVN uses clinical judgement in providing utilization management… more
- Sharp HealthCare (San Diego, CA)
- …decisive manner. + Able to manage difficult peer situations arising from medical care review . + Appreciation of cultural diversity and sensitivity towards target ... responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management, and concurrent and retrospective rev1ew process.… more
- Prime Healthcare (Lynwood, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... on the hospital for high quality and compassionate medical care . St. Francis is recognized for its full range...of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five… more
- Sutter Health (Emeryville, CA)
- …direction for critical health plan functions-including utilization management, credentialing, authorizations, concurrent review , and elements of claims review ... CMS Stars). + Experience managing utilization management, credentialing, authorization processes, and concurrent review in a plan or health system context. +… more
- Actalent (Sacramento, CA)
- …Working knowledge of EZ-CAP, EZ-Net, InterQual, and MCG preferred. + Background in concurrent review or inpatient census oversight preferred. + Strong critical ... Utilization Review Nurse (LVN) - InpatientPrimary Responsibilities + Perform...or ambiguous cases to the Medical Director or Physician Reviewer . + Ensure complete, accurate, and compliant documentation aligned… more
- Amergis (Orange, CA)
- …Qualifications: + Utilization management reviewer experience. + Managed care experience. + Behavioral health clinical experience. Required Licensure ... and ancillary providers. The incumbent will be responsible for prior authorizations, concurrent review and related processes. Position Details: Location: Orange… more
- Providence (Santa Rosa, CA)
- …opportunities for advancement. **Requsition ID:** 382655 **Company:** Providence Jobs **Job Category:** Care Management **Job Function:** Clinical Care **Job ... **Description** Care Manager RN - Case Management at Providence...management, medical staff and medical center personnel. Provides payor/utilization review organizations with concurrent retrospective utilization … more
- Stanford Health Care (Menlo Park, CA)
- …(AOI) provides leadership and oversight for complex, high-impact projects that drive clinical and operational growth across Stanford Health Care . This role ... lean culture that focuses on goals, metrics and continuous improvement, FS&P provides non- clinical operational support to Stanford Health Care and other Stanford… more
- Magellan Health Services (San Diego, CA)
- … care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against ... Education - Preferred License and Certifications - Required LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - … more
- CVS Health (Sacramento, CA)
- …+ 1 year of varied UM (utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety ... + 1 year of varied UM (utilization management) experience within an inpatient, concurrent review or prior authorization. + Remote work experience. **Education**… more