- CVS Health (Sacramento, CA)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- CVS Health (Sacramento, CA)
- …of varied UM ( utilization management) experience within an inpatient, concurrent review or prior authorization. + Remote work experience. **Education** + ... demonstrated ability to make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted license in their state… more
- Stanford Health Care (Palo Alto, CA)
- …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure and/or Compact ... This is a hybrid role having a combination of remote and onsite as scheduled. Whether this would be...include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review … more
- CenterWell (Sacramento, CA)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...on excellent service to others. **Required Qualifications** + Active RN license + Possession of or ability to obtain… more
- CenterWell (Sacramento, CA)
- …and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain… more
- Sharp HealthCare (San Diego, CA)
- …BBS Licensed Marriage and Family Therapist (LMFT) - CA Board of Behavioral Sciences; California Registered Nurse ( RN ) - CA Board of Registered Nursing ... (AHA BLS Healthcare) - American Heart Association + California Registered Nurse ( RN ) - CA...in use.Is knowledgeable of current laws and regulations regarding Utilization Review and Discharge Planning.Morning arrival time… more
- Magellan Health Services (San Diego, CA)
- …Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... This is a remote position in California, candidates must be licensed...member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care… more
- Sharecare (Sacramento, CA)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Stanford Health Care (Palo Alto, CA)
- …active: + CCDS - Cert Clinical Document Spec . + CCDS-O or CDIP . + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred ... + ICU/ED and Academic Medical Center experience preferred. + Case management, utilization review and/or direct provider interaction experience, preferred. +… more
- Molina Healthcare (Oakland, CA)
- …Practical Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. ... Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state… more