- CVS Health (Sacramento, CA)
- …in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Commander, Navy Installations (San Diego, CA)
- …and risk management activities, including Ongoing Professional Practice Evaluation, peer review and clinical case consultation on FAP treatment. Coordinate ... Summary Serve as a Non- medical Clinical Counselor within Commander, Navy Installations Command...Family Advocacy Program (FAP) (40%) Provide initial and on-going case management services. Triage clients, educate on mandated and… more
- Elevance Health (Rancho Cordova, CA)
- **Telephonic Nurse Case Manager II** **Sign on Bonus: $5000.** **Location: This role enables associates to work virtually full-time, with the exception of required ... different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- Sutter Health (Burlingame, CA)
- …team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and… more
- Sutter Health (San Francisco, CA)
- …team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and… more
- Prime Healthcare (Victorville, CA)
- …the continuum of the health care management. Supports ECM patients with complex medical conditions and completes medication reconciliation in collaboration with ... and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
- Sandia National Laboratories (Livermore, CA)
- …of onsite work and working from home) + Generous vacation, strong medical and other benefits, competitive 401k, learning opportunities, relocation assistance and ... Team (PRT). This PRT Integration Lead role will require review and critique of technical development efforts by a...with mechanical engineering and product realization in the NNSA complex . + Strong verbal and written communication skills, ability… more
- Gilead Sciences, Inc. (Foster City, CA)
- …company that discovers, develops and commercializes innovative medicines in areas of unmet medical need. We strive to transform and simplify care for people with ... centric, science focused company. Reporting to the Executive Director of Global Medical Affairs Technology, this individual will be responsible for driving delivery… more
- Evolent (Sacramento, CA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek… more
- Dignity Health (Rancho Cordova, CA)
- …reach determination. - Preps case thoroughly, concisely and clearly for physician review . Researches EMR, criteria, medical policy and past history of member ... health plan websites. Demonstrates 100% accuracy of identification of medical group member before referral review is...meeting deadlines. - Ability to apply clinical judgment to complex medical situations and make quick decisions.… more