- 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 ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- CVS Health (Sacramento, CA)
- …UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience ... with multi-state/compact privileges and have the ability to be licensed in all noncompact states. + Required to use...call center environment. + 1 year of varied UM ( utilization management) experience within an inpatient, concurrent review… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patiens receive… more
- Prime Healthcare (Chino, CA)
- …for its quality, including as among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3.… more
- Prime Healthcare (San Dimas, CA)
- …effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service ... Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care… more
- Magellan Health Services (San Diego, CA)
- This is a remote position in California, candidates must be licensed and reside in CA. This position is responsible for the assessment, reassessment, care planning ... member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care...of its assigned care support team and work with non- licensed support staff to meet standards of care and… more
- Sharp HealthCare (San Diego, CA)
- …response to therapeutic interventions via collateral calls, conjoint therapy sessions, utilization review process, and/or referrals and revises care plan ... **FTE** 1 **Shift Start Time** **Shift End Time** Master's Degree; California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral Sciences; AHA Basic… more
- Sharp HealthCare (San Diego, CA)
- …response to therapeutic interventions via collateral calls, conjoint therapy sessions, utilization review process, and/or referrals and revises care plan ... Healthcare Professional (AHA BLS Healthcare) - American Heart Association; California BBS Licensed Marriage and Family Therapist (LMFT) - CA Board of Behavioral… more
- Centene Corporation (Sacramento, CA)
- …of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + For Health Net of ... current CA license.** **Must have** **2-4 years related** **experience in UM-Concurrent Review . 2+ years of acute care experience required. 10% Travel required.**… more
- Molina Healthcare (Los Angeles, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_3-12 DAY SHIFT 7:30AM - 08:30PM PACIFIC HOURS NON EXEMPT, 3 days a week will… more