- LA Care Health Plan (Los Angeles, CA)
- … facility, outpatient needs (home health, physical therapy, infusion), and case management referrals (5%) Performs prospective, concurrent, post-service, and ... acute hospital setting. Previous experience to have a strong understanding of Utilization Management / Case Management practices including, but not limited to,… more
- CVS Health (Sacramento, CA)
- …is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH ... to coordinate, document and communicate all aspects of the utilization/benefit management program. + Utilizes clinical experience and skills in a collaborative… more
- Actalent (Redlands, CA)
- …and obtain appropriate contracts as necessary. + Identify cases requiring additional case management and coordinate care with relevant departments. + Collaborate ... Milliman Criteria Guidelines. + Proficiency in prior authorizations and case management . + Knowledge of NCQA standards....School Diploma or GED required; Bachelor of Science in Nursing or other clinical advanced degree preferred. + 1+… more
- Sutter Health (Modesto, CA)
- …Work + OR Master's (or current enrollment with completion within 2 years) in Case Management or Health Administration with relevant acute hospital experience + ... Masters in Social Work) **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California + OR LCSW-Licensed Clinical Social Worker...A broad knowledge base of health care delivery and case management within a managed care environment… more
- Actalent (Santa Barbara, CA)
- …Qualifications + Active, unrestricted California RN license + Minimum 2 years of clinical nursing experience (ambulatory, case management , or UM preferred) + ... Utilization Management Nurse (RN) - Santa Barbara, CA Hourly Rate: $50-$53/hr Location: On-site in Santa Barbara, CA Schedule: Full-time, Monday-Friday (no… more
- Alameda Health System (Alameda, CA)
- …referred by other healthcare providers or identified through assessment. Assists Care Management Nurse with discharge planning efforts as requested; obtains or ... Education with Required Experience: Two years of Social work or Case Management experience in an acute setting or protective services. Preferred… more
- Alameda Health System (San Leandro, CA)
- …referred by other healthcare providers or identified through assessment. Assists Care Management Nurse with discharge planning efforts as requested; obtains or ... MINIMUM QUALIFICATIONS: Required Experience: Two years of Social work or Case Management experience in an acute setting or protective services. Preferred… more
- Providence (Anaheim, CA)
- …Degree in Nursing or Master's Degree in related field. + Certification in Case Management (CCM, ACM) upon hire. + Specialty Certification in Oncology, Rehab, ... **Required qualifications:** + Graduate of an accredited school of nursing . + California Registered Nurse License upon...Care upon hire. + 3 years Experience in utilization management or case management . **Why… more
- Sutter Health (Modesto, CA)
- …fashion. He/She collaborates with patients, families, physicians, the interdisciplinary team, nursing management , quality, ancillary services, third party payers ... : **EDUCATION:** + Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN-Registered Nurse ...A broad knowledge base of health care delivery and case management within a managed care environment.… more
- Providence (Tarzana, CA)
- …and directing activities of assigned departments/areas of responsibility which include Case Management Department. The position reports to the Assistant ... + Bachelor's Degree Healthcare related field. + Upon hire: California Registered Nurse License + Management experience in a hospital/health care environment.… more