- CVS Health (Sacramento, CA)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan language… 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
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- Ventura County (Ventura, CA)
- …Under direction, scheduled as needed to assist with patient care coordination and utilization review . The incumbent will be responsible to assist with evaluation ... Per Diem Registered Nurse II/III - Utilization Management VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem… more
- Health Advocates Network (Arcata, CA)
- Benefits We Offer: + Comprehensive health, prescription, dental, vision, life, and disability plans + Competitive pay rates + Referral opportunities ? Refer a friend ... & Cash in! + Travel reimbursement and per diem allowances + Employee discounts + Educational opportunities Health Advocates Network was founded based on a shared aspiration to improve the way healthcare staffing is done. We are a company founded by healthcare… more
- Actalent (Redlands, CA)
- …with internal staff to ensure seamless care coordination. Essential Skills + Utilization review and management experience. + Familiarity with Medicare, MediCal, ... Job Title: Remote LVN Case Manager - Utilization Management Job Description Join our dynamic Utilization Management team as an LVN Case Manager where you will… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patiens receive… more
- Humana (Sacramento, CA)
- …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- Molina Healthcare (San Diego, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_3-12 DAY SHIFT 7:30AM - 08:30PM PACIFIC HOURS NON EXEMPT, 3 days a week will… more
- Molina Healthcare (Sacramento, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **WORK SCHEDULE: Mon - Fri /… more