- CVS Health (Sacramento, CA)
- …UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience ... a high-volume clinical call center environment. + 1 year of varied UM ( utilization management) experience within an inpatient, concurrent review or prior… more
- 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
- 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,...accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum… 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 ... accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum...graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3.… more
- Centene Corporation (Sacramento, CA)
- …Knowledge of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + For Health ... 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
- 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
- Veterans Affairs, Veterans Health Administration (Loma Linda, CA)
- …and privileges and functions within the scope of practice for a licensed NP. Ongoing collaboration with physicians, nursing staff, radiology technologists, and other ... under the direct supervision of assigned physician preceptor. The preceptor will review medical records and clinical practice of the NP Responsibilities Duties… more
- CVS Health (Sacramento, CA)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Cedars-Sinai (Los Angeles, CA)
- …direct and indirect clinical care services to selected patients within the licensed scope of practice, including diagnosis and treatment, under the supervision of ... plans to track outcomes for patients in value-based programs, including utilization , cost, efficiency, and appropriateness metrics, as well as clinical outcomes.… more