- 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
- Actalent (Redlands, CA)
- …with internal staff to ensure seamless care coordination. Essential Skills + Utilization review and management experience. + Familiarity with Medicare, MediCal, ... Job Title: Remote LVN Case Manager - Utilization Management Job Description Join our dynamic Utilization Management team as an LVN Case Manager where you… more
- Humana (Sacramento, CA)
- …Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** ... of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity… more
- CenterWell (Sacramento, CA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Sacramento, CA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- Sharp HealthCare (San Diego, CA)
- …selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations. + Participates in the retrospective ... responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management, and concurrent and retrospective rev1ew process.… more
- Sharp HealthCare (San Diego, CA)
- …selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations for updating current polices to meet ... and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management, and concurrent and retrospective review … more
- Centene Corporation (Sacramento, CA)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… 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 ... care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity… more