- Dignity Health (Rancho Cordova, CA)
- …position is hybrid in-office/clinic (Rancho Cordova and Woodland) and work from home .** **Position Summary:** Under the guidance and supervision of the department ... Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic… more
- Sacramento Municipal Utility District (Sacramento, CA)
- …bodies. + Plans and directs the performance of technical analyses on utilization and reliability of SMUD's generation and bulk transmission system by overseeing ... and discrepancies; maintaining project records and files; participating in the overall review of the completed project results; and making recommendations for next… more
- CenterWell (Sacramento, CA)
- …potential market events that would drive unanticipated changes in cost and utilization . The team also leads our trend detection process, responsible for identifying ... month, quarter over quarter and year over year trend review and ad hoc as needed + Proactively monitors...time that is best for your schedule **Work at Home requirements:** To ensure Home or Hybrid… more
- Evolent (Sacramento, CA)
- …developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk- based models.** + Process ... role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a **Cardiologist** to… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... With more than 700 care sites across the US, from clinics and hospitals to home - based care and virtual care services, CommonSpirit is accessible to nearly one… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... With more than 700 care sites across the US from clinics and hospitals to home - based care and virtual care services CommonSpirit is accessible to nearly one out… more
- Humana (Sacramento, CA)
- …**Use your skills to make an impact** **Required Qualifications** + Experience with Utilization Review and/or Prior Authorization within a managed care call ... Prior member service or customer service telephone experience desired **Work-At- Home Requirements** To ensure Home or Hybrid...posting. The pay range may be higher or lower based on geographic location and individual pay will vary… more
- Humana (Sacramento, CA)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health insurance organizations,… more
- Humana (Sacramento, CA)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance organizations,… more
- Insight Global (Sacramento, CA)
- …care is being delivered Participates in the Outcomes Management and annual program review Performs utilization review of continuous care and inpatient ... performance levels through making field visits, evaluating documentation and providing team based in services on Vitas values, hospice principles and practices and… more