- HCA Healthcare (Riverside, CA)
- …Nurse (RN) with current California license required, Case Management Certification or utilization review preferred + Associate's Degree minimum required + ... what matters most to nurses like you - at home , at work, and at every stage in your...to apply for our Coord Case Mgmt opening. We review all applications. Qualified candidates will be contacted by… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... emphasis will be on care coordination communication and collaboration with utilization management nursing physicians ancillary departments insurers and post acute… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute… more
- Humana (Sacramento, CA)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health ... health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization,… more
- AON (Los Angeles, CA)
- …the world. The AGCN provides counsel and advice at the local and home office levels, helping global organizations identify and manage various types of risks ... client service for assigned book of business including billing, policy collection, review and transmittal in accordance with established service standards. + Liaise… more
- Evolent (Sacramento, CA)
- …to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through collaboration ... prior authorization lists, facilitating timely decision-making for clinical and business review teams. + Demonstrate strong analytical abilities, with a proven track… more
- Evolent (Sacramento, CA)
- …role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a **Cardiologist** to ... cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based models.** + Process improvement and… more
- VNA Health (Santa Barbara, CA)
- …and directs home care services. Responsibilities: + Responsible for continuous review of all aspects of every patient on his/her caseload to include: appropriate ... Registered Nurse Case Managers (RN CM) to join our Home Health care team. The RN CM plans, organizes... utilization of services; ensuring continued skilled need; monitoring of… more
- Humana (Sacramento, CA)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance organizations,… more
- Humana (Sacramento, CA)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health insurance organizations,… more