- Sedgwick (Sacramento, CA)
- …**PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of ... and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or...to the next round, recruiter will be in touch. \# nurse #medicare #medicaresetaside _As required by law, Sedgwick provides… more
- Alameda Health System (Oakland, CA)
- …Their responsibilities span from managing admissions to ensuring clean claims , identifying trends, and optimizing resource utilization. This role supports ... in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + Monitor and evaluate… more
- Elevance Health (Walnut Creek, CA)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... I** is responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing incoming calls or… more
- Sutter Health (Modesto, CA)
- …quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and… more
- Sutter Health (Modesto, CA)
- …quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and… more