- Cognizant (Sacramento, CA)
- …guidelines and regulations + Experience in the analysis and processing of claims, utilization review /quality assurance procedures + Must be able to work with ... technologies to transform a variety of business operations. We are seeking **Fully Remote US Based** Claims Processors to join our growing team. The **Medical**… more
- Niagara Bottling LLC (Diamond Bar, CA)
- …Team Members. Sr. Manufacturing Technology Specialist - Warehouse Excellence ( Remote ) The Sr. Manufacturing Technology Specialist (Warehouse Excellence Team) ... with the Manufacturing Technology Manager + Provides a final technical review of all eLearning courseware + Communicate effectively with training stakeholders… more
- Cognizant (Sacramento, CA)
- …+ Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Excellent problem-solving skill in ... team and collaborate with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper or EDI… more
- Sharecare (Sacramento, CA)
- …techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also ... in the orientation and to take the pre and post tests to review competency during orientation. Yearly competency tests are required for all Sharecare clinicians.… more
- Anywhere Real Estate (Riverside, CA)
- …problems; + Work with the Engineering team to conduct design and peer code review ; + Acquire knowledge of existing systems and the underlying business processes they ... customers, analysts, data scientists, and operations teams which will increase the utilization of our products and achieve competitive advantage; + Remain abreast of… more
- Stanford Health Care (Palo Alto, CA)
- …+ ICU/ED and Academic Medical Center experience preferred. + Case management, utilization review and/or direct provider interaction experience, preferred. + ... Experience in public speaking, as well as educational content creation and delivery of formal multidisciplinary education, preferred. + Experience with Vizient, Premier, Elixhauser and other risk adjustment methodologies, highly preferred. **Required… more
- Molina Healthcare (Oakland, CA)
- …Licensed Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable ... state and federal regulations. **Required License, Certification, Association** Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse (RN) Program… more
- The Cigna Group (Sacramento, CA)
- …Cigna Medical Sales organization. + Participate in client meetings and presentations to review client performance and to offer and successfully sell in a suite of ... finalist meetings for new and existing business where necessary. + Analyze pharmacy utilization in order to provide clients with consultative solutions as well as… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... This is a hybrid role having a combination of remote and onsite as scheduled. Whether this would be...requested clinical and psychosocial information to assure reimbursement. + Utilization Review -- Reviews prospectively, concurrently and… more
- Humana (Sacramento, CA)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more