- Elevance Health (Walnut Creek, CA)
- ** Utilization Management Representative I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person ... Friday, an 8-hour shift between 8 am - 8 pm EST. The ** Utilization Management Representative I** is responsible for coordinating cases for precertification and prior… 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
- Amazon (Palo Alto, CA)
- …the Role This position will be part of the Sponsored Product Demand Utilization team within the Amazon Advertising organization. You will work hands-on with ... talented scientists while delivering impact across teams in the SP Demand Utilization Org. You will have experience working with multiple stakeholders across the… 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
- CenterWell (Sacramento, CA)
- …Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more
- Humana (Sacramento, CA)
- …into concrete roadmaps that will generate tangible value to all stakeholders. Within Utilization Management, our goal is to enable members to receive the most ... appropriate type of care as quickly as possible all while streamlining processes for our provider partners and reducing unnecessary costs from the healthcare system. Our team employs a rigorous process to set specific business priorities, identifies the… more
- Amergis (French Camp, 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
- Prime Healthcare (Redding, CA)
- …(https://careers-primehealthcare.icims.com/jobs/222168/social-worker-ii utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... FacilityShasta Regional Medical Center LocationUS-CA-Redding ID2025-222168 CategoryClinical Professional Position TypeFull Time ShiftDays Job TypeNon-Exempt more
- Rady Children's Hospital San Diego (San Diego, CA)
- JOB SUMMARY: Under the supervision of the Utilization Management (UM) Operations Supervisor, the UM Coordinator I's primary job function is to support UM operations ... by performing any non-clinical tasks. This includes, but is not limited to, initial authorization processing, (data entry, eligibility verification, benefits verification, and requesting required supporting documents from submitting provider offices),… more
- CVS Health (Sacramento, CA)
- …active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... unrestricted RN license in the state you reside. + 5 years demonstrated to make thorough independent decisions using clinical judgement. + 5 Years proficient use of equipment experience including phone, computer, etc and clinical documentation systems. +… more