- Elevance Health (Costa Mesa, CA)
- **Nurse Demand Management ** **Sign On Bonus:$3,000** Carelon Health is a proud member of the Elevance Health family of brands, offering clinical programs and ... - 7AM EST & Friday - Sunday 7PM - 7:30AM EST** The **Nurse Demand Management ** is responsible for telephone triage to assess caller's needs and provide relevant … more
- Highmark Health (Sacramento, CA)
- …experience in health - or insurance -related field + 5 years Health Insurance experience in applicable market segment + State-specific Producer License ... to achieve and/or exceed upselling opportunities. Responsible for market management (ie, awareness and management of external...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996… more
- Highmark Health (Sacramento, CA)
- …Infrastructure Library (ITIL) **SKILLS** + Knowledge of regulatory requirements such as Health Insurance Portability and Accountability Act (HIPPA), Payment Card ... **JOB SUMMARY** This job provides Information Security and Risk Management services for the Organization. Works with peers within...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996… more
- Sutter Health (Sacramento, CA)
- …effective, efficient utilization of health care services. The PA meets with care management , UM staff and health care team members and medical directors of ... act as a liaison between the CDI (Clinical Documentation Improvement) professional, HIM ( Health Information Management ) ,and the hospital's medical staff to… more
- Elevance Health (CA)
- …Experiences:** + Utilization Management experience is strongly preferred. + Health insurance billing and/or medical coding experience is strongly preferred. ... **Medical Management Clinician Senior** **Location:** This role enables associates...providers and internal and external customers to help improve health outcomes for members. + Refers complex or unclear… more
- Elevance Health (Los Angeles, CA)
- **Medical Management Nurse** **Hours: Candidates will work** **8a-5pm PST with 1 weekend per year-open for weekend work holidays voluntary** **Location** : This role ... accommodation is granted as required by law. The **Medical Management Nurse** is responsible for review of the most...unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable… more
- Alameda Health System (San Leandro, CA)
- …Experience: Three years in a health care field or one year in Utilization Management at a Medical Group or Health plan experience; electronic Health ... SLH Care Management Specialist + San Leandro, CA + San...required for the completion of forms received from patients' insurance carriers. + Perform all other duties as assigned.… more
- Alameda Health System (Oakland, CA)
- Nurse, Care Management + Oakland, CA + Highland General Hospital + HGH Care Coordination + Full Time - Day + Care Management + $77.67 to $113.98 per hour + Req ... alternative levels of care, and identifies cost-effective protocols. Care Management provides Care Coordination, Compliance, Transition Coordination, and Utilization… more
- Elevance Health (Walnut Creek, CA)
- …and Experiences:** + BS preferred. + MS Office Suite experience preferred. + Health plan experience preferred. + Management experience preferred. + Production ... **Manager II Medical Management ** **Location:** This role requires associates to be...active, valid unrestricted RN license to practice as a health professional within the scope of licensure in applicable… more
- Alameda Health System (Oakland, CA)
- …degree in Nursing Required Experience: Three years of utilization review experience. Health insurance company and/or acute care hospital, post-acute and psych; ... Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic planning, compliance,… more