- CVS Health (Sacramento, CA)
- …for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities** + Apply critical ... a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM...some weekends and holidays, per URAC and client requirements. ** Remote Work Expectations** + This is a 100% … more
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...Experience a plus + Bilingual is a plus **Workstyle:** Remote work at home **Location:** Must reside in a… more
- Sharecare (Sacramento, CA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (Sacramento, CA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...Obstetrics experience . **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- Centene Corporation (Sacramento, CA)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Centene Corporation (Sacramento, CA)
- …levels of care and facilities + Partners with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners ... findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and… more
- Evolent (Sacramento, CA)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Centene Corporation (Sacramento, CA)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Sharp HealthCare (San Diego, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... policy.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- Rady Children's Hospital San Diego (San Diego, CA)
- GASTROENTEROLOGY Outpatient Nurse POSITION DETAILS: Schedule: Days, 8-10 hour shifts (not remote ) FTE: PART Time, 32 hours per week, 64 per pay period JOB ... procedures to perform education and advice to patients, in clinic procedures and nurse run visits, manages patient requests and needs via telephone triage and… more