- CVS Health (Sacramento, CA)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current and ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma RN acceptable;… more
- Emanate Health (Covina, CA)
- …and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying ... or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and level of care reviews for requested… more
- Prime Healthcare (San Dimas, CA)
- …communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use ... institution in a Health and Human Services field is highly preferred. + Utilization Review experience is highly preferred. + Must meet the performance standards set… more
- Prime Healthcare (Inglewood, CA)
- …and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive ... case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Additionally,… more
- Elevance Health (Walnut Creek, CA)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... 8:35 AM to 5:05 PM Pacific. Training hours may vary. The ** Utilization Management Representative I** is responsible for coordinating cases for precertification and… more
- Prime Healthcare (Montclair, CA)
- …EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions, in both ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/221097/discharge-planner utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityMontclair Hospital Medical… more
- CenterWell (Sacramento, CA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare +… more
- Sharp HealthCare (San Diego, CA)
- …track and maintain this certification.For Sr Spec ICM assigned to Utilization Management, Train-the-Trainer certification may substitute for ACM or CCM. **Essential ... track and maintain this certification.For Sr Spec ICM assigned to Utilization Management, Train-the-Trainer certification may substitute for ACM or CCM. **Knowledge,… more
- ERP International (Vandenberg AFB, CA)
- **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Utilization Management** for a temporary contract position in support of the30th ... Medical Group at Vandenberg AFB, CA (https://www.airforcemedicine.af.mil/MTF/Vandenberg/About-Us/) . **NOTE: This is NOT a Tele-Health/Remote Practice Opportunity.** **Be the Best!** Join our team of exceptional health care professionals across the nation.… more
- Amergis (Santa Rosa, CA)
- …continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Minimum ... Requirements: + Current RN licensure in state practicing + At least one year of Case Management experience preferred + Current CPR if applicable + TB questionnaire, PPD or chest x-ray if applicable + Current Health certificate (per contract or state… more