- CVS Health (Sacramento, CA)
- …Under the direction of the Lead Clinical Psychologist, this position will focus on utilization , quality, and review of fraud, waste, and abuse for individual ... with heart, each and every day. **This is full-time, remote position. Candidates can reside anywhere in the US...Aetna member cases. **Expectations/Responsibilities:** + Review and prepare cases for medical necessity … more
- CVS Health (Sacramento, CA)
- …And we do it all with heart, each and every day. **Position Summary** Fully remote , Monday-Friday 8am - 5pm EST position (shifts may vary based on business needs) ... level. The Associate Manager is also responsible for oversight of utilization management nurses including the organization and development of high performing… more
- Fujifilm (Sacramento, CA)
- …identifying activities, sponsorships, and equipment needed to ensure success. + Review and consideration of event participation levels and requirements, involving ... key stakeholders as needed, and share with review committee for consideration. + Timely, proactive sharing and...data monitoring, analysis, summary, and report generation for sales utilization of Showpad materials and platform, including areas of… more
- Ventura County (Ventura, CA)
- …9/80 workweek) may be available for some positions. + Telework Schedule - A remote hybrid telework schedule may be available for some positions. + Vacation Accrual - ... areas of responsibility include, but are not limited to, compliance review , budgeting, grant accounting, cost accounting and financial analysis/reporting duties. At… 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
- LA Care Health Plan (Los Angeles, CA)
- …with internal departments (Member Services, Provider Network Operations, Claims, Utilization Management, Pharmacy, and Quality Management) to ensure the use ... member correspondence for accuracy, clarity, and cultural appropriateness and sensitivity. Review grievance and State Fair Hearing files for compliance with Policies… more
- BD (Becton, Dickinson and Company) (San Diego, CA)
- …long-term adoption of MMS technologies by helping the customer optimize the utilization of the solutions they purchase and demonstrate realized returns on ... long-term adoption of MMS technologies by helping the customer optimize the utilization of the solutions they purchase and demonstrate realized returns on… more
- Humana (Sacramento, CA)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- Humana (Sacramento, CA)
- …for requested services using clinical judgment and refers to internal stakeholders for review depending on case findings. + Educates providers on utilization and ... and ability to troubleshoot and resolve basic technical difficulties in a remote environment + Ability to work independently under general instructions and with… more
- Humana (Sacramento, CA)
- …and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy ... develop and maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is seeking a Senior… more