- 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
- 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 (Sacramento, CA)
- …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- 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
- 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
- Molina Healthcare (San Diego, 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 (Sacramento, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and...+ Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested,… more
- Amergis (French Camp, CA)
- …40 hours per week RNs will be doing denials, discharge planning, and utilization review Hiring points for a perfect candidate: Current Discharge Planning ... ensuring optimumutilization of resources, service delivery, and compliance with medical regime. Minimum Requirements: + Current RN licensure in...experience Utilization review InterQual experience Working with multidisciplinary… more
- Amergis (French Camp, CA)
- …40 hours per week RNs will be doing denials, discharge planning, and utilization review **Needs Case Manager Experience in ACUTE setting** Current Discharge ... Planning experience Denials experience Utilization review experience InterQual experience Working with multidisciplinary teams Knowledge of current Medicare… more
- 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
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