- Centene Corporation (Sacramento, CA)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care ...teams to review care services related to Applied Behavior… more
- Emanate Health (Covina, CA)
- …indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and ... #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records...of care reviews for requested services using clinical judgment and refer to Medical Directors for … more
- LA Care Health Plan (Los Angeles, CA)
- …Actively participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care , home health, ... Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type:… more
- Trinity Health (Fresno, CA)
- **Employment Type:** Full time **Shift:** **Description:** This position coordinates utilization review service for defined patient populations across the acute ... care continuum. This includes discharge planning, utilization ...Previous experience in at least two (2) areas of clinical specialty in an acute care setting… more
- CVS Health (Sacramento, CA)
- …active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan… more
- Prime Healthcare (Ontario, CA)
- …working for a Health Plan. + At least 3 years of experience in utilization review , referrals, authorizations, denials and appeals. + Current BCLS (AHA) ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/211752/ utilization - review -rn/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306)… more
- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/219588/case-manager%2c-rn utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... on the hospital for high quality and compassionate medical care . St. Francis is recognized for its full range...designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a… more
- CVS Health (Sacramento, CA)
- … Management. AHH delivers flexible medical management services that support cost-effective quality care for members. + Work in clinical telephone queue for 3 ... a day working with providers to secure additional information for prior authorization review . + This candidate will utilize clinical skills to coordinate,… more
- Alameda Health System (Oakland, CA)
- …Master's degree in Nursing Required Experience: Three years of utilization review experience. Health insurance company and/or acute care hospital, post-acute ... each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. +… more
- Ventura County (Ventura, CA)
- …Benefits + Questions Description Under direction, scheduled as needed to assist with patient care coordination and utilization review . The incumbent will be ... needs; + Coordinates the interdisciplinary approach to providing continuity of care , including Utilization management, Transfer coordination, Discharge planning,… more