- 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:** + RN -… more
- CenterWell (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... high-volume community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a… more
- Magellan Health Services (San Diego, CA)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or… more
- Magellan Health Services (San Diego, CA)
- …manage and oversee activities of assigned care support teams. Experience with Care Management flows. Knowledge of utilization management procedures, mental ... This is a remote position in California, candidates must be licensed...and effective person-centered care plan, member education and care management . Conducts initial and concurrent review for prior authorization… more
- Stanford Health Care (Palo Alto, CA)
- …+ ICU/ED and Academic Medical Center experience preferred. + Case management , utilization review and/or direct provider interaction experience, preferred. ... Health Care **What you will do** + Responsibility for management and optimization of the positive relationships between CDI...+ CCDS-O or CDIP . + Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred… more
- Dignity Health (Bakersfield, CA)
- …expert clinical and education resource; staff and leadership development consultant; and Utilization Management content expert for staff, leaders, physicians and ... **Responsibilities** This position is remote .** **Position Summary:** This position will act as...customers across the ePH Utilization Management . This position will assist with… more
- GE Aerospace (San Francisco, CA)
- …a change agent for business processes related to Government Property (GP) management at subcontractor and affiliate sites, driving improvements and compliance. + ... Provide assistance with the management of the GP subcontractor and affiliate risk assessment and surveillance audit process to ensure compliance and mitigate risks.… more
- Fresenius Medical Center (Rancho Cucamonga, CA)
- Remote role with up to 60% travel **PURPOSE AND SCOPE:** Develops, implements, maintains and evaluates an effective, data-driven, quality assessment and performance ... barriers to quality improvement. This includes promoting the adoption and utilization of Corporate Medical Advisory Board Recommended Algorithms and Standing Orders,… more
- CommonSpirit Health (Rancho Cordova, CA)
- …within multiple markets in a region. Oversees the centralized functions of Utilization Management Services, including but not limited to medical necessity ... SanFrancisco, Santa Cruz and Redwood City** **This is a remote position however the incumbent must reside in the...reviews and denials management . Oversees Clinical Care Coordination functions within the facilities… more
- J&J Family of Companies (Los Angeles, CA)
- …Immunology work experience Must be familiar with Microsoft Word, Excel, PowerPoint, and utilization of computers and remote technologies Reside in or near Los ... their skills and agility, applying the competencies of Change Management , Time Management and Innovation. The MSL...PharmD, PhD, MD, or other advanced medical degree, NP ( Nurse Practitioner), PA (Physician Assistant)), with 2+ years relevant… more