- Providence (Napa, CA)
- **Description** Care Manager RN - Utilization Review unit at Providence Queen of the Valley Medical Center in Napa, CA. This position is Full-Time and will work ... Schedule:** Full time **Job Shift:** Day **Career Track:** Nursing **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work… more
- Sutter Health (Sacramento, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... meeting the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA will develop expertise on matters… more
- Dignity Health (Woodland, CA)
- …Woodland, CA, with occasional onsite meetings in Woodland.** **Position Summary:** The Utilization Review LVN uses clinical judgement in providing utilization ... position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilties may include: - Determines… more
- Trinity Health (Fresno, CA)
- **Employment Type:** Full time **Shift:** **Description:** This position coordinates utilization review service for defined patient populations across the acute ... care continuum. This includes discharge planning, utilization management, care coordination collaboration, and support...familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial… more
- 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 ... Occasional Overtime may be required. This position will be remote working from home anywhere in the US. **Position Summary** + Utilizes clinical experience and… more
- LA Care Health Plan (Los Angeles, CA)
- …providing clinical review and authorization for alternate levels of care, home health, durable medical equipment, and other discharge needs. Provides support to ... Utilization Management Admissions Liaison RN II Job Category:...Management Medical Director, on requests where determination requires extended review . Collaborates with the inpatient care team for facilitation/coordination… more
- CVS Health (Sacramento, CA)
- …UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience ... required including acute care, home health, or long-term care. + 5 years demonstrated...call center environment. + 1 year of varied UM ( utilization management) experience within an inpatient, concurrent review… more
- Humana (Sacramento, CA)
- …Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** ... community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for...is best for your schedule. **WAH Requirements:** To ensure Home or Hybrid Home /Office employees' ability to… more
- CenterWell (Sacramento, CA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Sacramento, CA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more