- 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
- 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
- CBRE (Sacramento, CA)
- Global Finance Director - Remote Job ID 233748 Posted 13-Aug-2025 Service line GWS Segment Role type Full-time Areas of Interest Accounting/Finance, Administrative, ... Data & Analytics, Project Management Location(s) Remote - US - Remote - US...special projects and prepares presentations for senior management. Facilitates review and approval of capex projects in accordance with… more
- CVS Health (Sacramento, CA)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Merck (Sacramento, CA)
- …support, educational or risk management) to support appropriate and safe utilization of Our Company medicines or vaccines. **Required Qualifications, Skills & ... days may vary by site or organization, with Friday designated as a remote -working day, unless business critical tasks require an on-site presence.This Hybrid work… more
- Highmark Health (Sacramento, CA)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Cognizant (Sacramento, CA)
- …experience. * Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. * Must be able to work with ... flexibility wherever possible. Based on this role's business requirements, this is a remote position open to qualified applicants in the United States. Regardless of… more
- Wolters Kluwer (Sacramento, CA)
- …opportunities in the named customer base, including: + Conducting regular account review meetings and reviewing account utilization management reporting to ... **_ This is a remote position covering the New England territory _**...communication **Travel Requirements** + 25-50% within territory \#LI - Remote _Applicants may be required to appear onsite at… more
- Optiv (San Francisco, CA)
- _This position will be fully remote and can be hired anywhere in the continental US_ The Practice Manager is a key leadership role within our Services consulting ... documented, up to date, and consistently applied across all projects + Review and approve project deliverables for accuracy, completeness, and alignment with… more