- Sutter Health (Sacramento, CA)
- …meeting the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA will develop expertise on matters ... regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices, level of care progression, denial… more
- Providence (Napa, CA)
- **Description** Care Manager RN - Utilization Review unit at Providence Queen of the Valley Medical Center in Napa, CA. This position is Full-Time and will work ... the continuum of care. The RN Case Manager assists patients in the utilization of appropriate health care services. Position may require Utilization Management… more
- Actalent (Redlands, CA)
- Job Title: Remote LVN Case Manager - Utilization Management Job Description Join our dynamic Utilization Management team as an LVN Case Manager where you will ... with internal staff to ensure seamless care coordination. Essential Skills + Utilization review and management experience. + Familiarity with Medicare, MediCal, and… more
- Actalent (Santa Barbara, CA)
- Utilization Management Nurse (RN) - Santa Barbara, CA Hourly Rate: $50-$53/hr Location: On-site in Santa Barbara, CA Schedule: Full-time, Monday-Friday (no weekends ... a detail-oriented and compassionate Registered Nurse to join a high-performing Utilization Management team supporting outpatient specialty care. This role is ideal… more
- Dignity Health (Woodland, CA)
- …Woodland, CA, with occasional onsite meetings in Woodland.** **Position Summary:** The Utilization Review LVN uses clinical judgement in providing utilization ... Strong knowledge nursing requirements in a clinical setting. - Knowledge of utilization management programs as related to pre-set protocols and criteria. - Knowledge… more
- Centene Corporation (Sacramento, CA)
- …and criteria + Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers as appropriate to discuss ... + Provides education to members and their families regrading ABA and BH utilization process + Provides feedback to leadership on opportunities to improve care… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by ... 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 (Inglewood, CA)
- …and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patiens receive ... case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Additionally,… more
- Humana (Sacramento, CA)
- …first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities ... new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- Prime Healthcare (San Dimas, CA)
- …EXPERIENCE, TRAINING Required qualifications. 1. Knowledge in discharge planning/ utilization management/case management terminology and functions, in both managed ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/214912/discharge-planner-ii-%28lvn%29 utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySan Dimas Community… more