- Centene Corporation (Sacramento, CA)
- …Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + For Health ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… 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
- Sharecare (Sacramento, CA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... the Family Health Advocate is an exciting and innovative remote role newly created to provide meaningful support to...+ Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex… more
- Sharp HealthCare (San Diego, CA)
- …VP for Clinical operations and Health Services to ensure timely submission of required Utilization , Case Management and Disease Management Work plans to ... Time** Bachelor's Degree in Nursing; Bachelor's Degree; Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Professional in… 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
- BrightSpring Health Services (Sacramento, CA)
- …of business development & growth, achievement of key performance indicators, management of nursing performance and staff development. Responsibilities * Oversees and ... performance reviews* Responsible to ensure that there is a nurse on call after hours for all homes (and...professional consultants and direct care in coordination with Operations management * Provides feedback to Operations management regarding… more
- J&J Family of Companies (San Francisco, CA)
- …TA and/or Immunology. + Must be familiar with Microsoft Word, Excel, PowerPoint, and utilization of computers and remote technologies. + Reside in or near San ... their skills in agility, applying the competencies of Change Management , Time Management and Innovation. The Sr....PharmD, PhD, MD, or other advanced medical degree NP ( Nurse Practitioner), PA (Physician Assistant), with +3 years relevant… more
- UCLA Health (Santa Monica, CA)
- …main functions: 1. Resource and complex care coordination 2. Project coordination/ management for innovative approaches to deliver behavioral health services to ... needs. You will aim to foster continuity of care and reduce unnecessary utilization of healthcare services by coordinating and providing health services that meet… more