- CVS Health (Sacramento, CA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse 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
- Elevance Health (Costa Mesa, CA)
- ** Telephonic Nurse Case Manager II** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person ... members in different states; therefore, Multi-State Licensure will be required.** The ** Telephonic Nurse Case Manager II** is responsible for care management… more
- Cedars-Sinai (Marina Del Rey, CA)
- …the established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review ... Hospitals! **What You Will Do in This Role:** A Registered Nurse Case Manager plans and coordinates...in Nursing (preferred). **Certifications/Licenses:** + Current and valid California RN License (required). + Certified Case Manager (CCM) or… more
- Stanford Health Care (Palo Alto, CA)
- …to identify trends and make recommendations for improvement. **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... + Reduce avoidable inpatient and SNF bed days through telephonic & in person concurrent review , proactive...to deal with technical queries. + Demonstrated ability to review utilization reports and data. + Ability… 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
- LA Care Health Plan (Los Angeles, CA)
- …Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse ( RN ); current and unrestrited California License. ... aggregate progress and individual ECM member cases. May use telephonic , onsite, or written methods and both group and...Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM)… more
- Actalent (Sacramento, CA)
- Utilization Review Nurse (LVN) - InpatientPrimary Responsibilities + Perform timely utilization reviews for Medicare inpatient admissions, continued ... Conduct in-person hospital rounds 2-3 days per week; perform telephonic reviews and participate in interdisciplinary case reviews. +...ICU). + At least 1 year of experience in utilization review , case management, or hospital discharge… more