- LA Care Health Plan (Los Angeles, CA)
- …including providing clinical review and authorization for alternate levels of care, home health , durable medical equipment, and other discharge needs. Provides ... but not limited to: Skilled nursing facility, outpatient needs ( home health , physical therapy, infusion), and case...Utilization Management or CM. Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and… more
- Sutter Health (Sacramento, CA)
- …Services (GR) Grouper (CMS) preferred. + Post-acute levels of care such as Home Health , Hospice, Advance Illness Management (AIM), and Palliative Care. Skilled ... the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA will develop expertise on matters… more
- CVS Health (Sacramento, CA)
- …authorization. + 5 years of a variety clinical experience required including acute care, home health , or long-term care. + 5 years demonstrated ability to make ... At CVS Health , we're building a world of health...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Rising Medical Solutions (Los Angeles, CA)
- …industrial rehabilitation nursing, medical case management, occupational health , orthopedics, home health care, utilization review, or quality assurance ... Benefits + Opportunity to make a difference in reducing health care costs and increasing the value of ...health care costs and increasing the value of health care to individuals and their employers + Compensation… more
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for ... + Mandatory overtime during peak season **Job Description:** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical professional responsible for… more
- Providence (Napa, CA)
- …planning, or utilization management experience in the acute, sub-acute, home health setting or managed care environment. **Preferred Qualifications:** + ... care. The RN Case Manager assists patients in the utilization of appropriate health care services. Position...groups and clinics, numerous outreach programs, and hospice and home care. Providence is proud to be an Equal… more
- Humana (Sacramento, CA)
- …ensuring best and most appropriate treatment, care or services for members utilizing Home Health and Skilled Nursing Facility services. This team sits in ... Prior member service or customer service telephone experience desired + Experience with SNF and/or Home Health + Prior experience with CGX, SRO and HCHB + Prior… more
- CVS Health (Sacramento, CA)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...be required. This position will be remote working from home anywhere in the US. **Position Summary** + Utilizes… more
- Humana (Sacramento, CA)
- …Desirables** + Health care industry experience **Workstyle:** Remote work at Home **Location:** US **Schedule:** M-F 8:00 AM to 5:00 PM Eastern **Travel:** None ... part of our caring community and help us put health first** The UM Strategy team is a multi-disciplinary...that will generate tangible value to all stakeholders. Within Utilization Management, our goal is to enable members to… more
- CenterWell (Sacramento, CA)
- …Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health . + Bilingual We offer tangible and intangible benefits such as ... largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is… more