• Utilization Management Nurse Consultant…

    CVS Health (Sacramento, CA)
    …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
    CVS Health (08/15/25)
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  • Staff Utilization Management Pharmacist

    Humana (Sacramento, CA)
    …conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization , and identifying unusual ... Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review ​ **Additional Information:** **Interview Format**… more
    Humana (08/13/25)
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  • Utilization Management Nurse

    CenterWell (Sacramento, CA)
    …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
    CenterWell (08/02/25)
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  • Utilization Management Nurse

    CenterWell (Sacramento, CA)
    …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
    CenterWell (08/08/25)
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  • Clinical Review Nurse - Concurrent…

    Centene Corporation (Sacramento, CA)
    …on member medical records in health management systems according to utilization management policies and guidelines + Works with healthcare providers to approve ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
    Centene Corporation (08/16/25)
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  • Medical Director, Ventura County Health…

    Ventura County (Ventura, CA)
    …+ Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + At ... care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review ...Review systems and programs + Direct patient care medical practice experience + Administrative experience + National Committee… more
    Ventura County (08/04/25)
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  • Care Review Clinician, Inpatient…

    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...requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and… more
    Molina Healthcare (08/08/25)
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  • Supv Regional Care Mgmt- Integrated Care Mgmt…

    Sharp HealthCare (San Diego, CA)
    …in-patient Care Management program that includes initial and concurrent review ; case management/discharge planning activities. Responsible for operational planning ... consistent with existing policies and/or principles. Responsible for managing medical management activities to include tracking, trending and analyzing UM data.… more
    Sharp HealthCare (07/09/25)
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  • Medical Director - Mid West Region

    Humana (Sacramento, CA)
    …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of...on size of region or line of business. The Medical Director conducts Utilization Management of the… more
    Humana (08/08/25)
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  • Medical Director- South Central

    Humana (Sacramento, CA)
    …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of...on size of region or line of business. The Medical Director conducts Utilization Management of the… more
    Humana (07/11/25)
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