- 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 ... organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA...(CMS) preferred. + Post-acute levels of care such as Home Health , Hospice, Advance Illness Management (AIM),… more
- Providence (Napa, CA)
- …planning, or utilization management experience in the acute, sub-acute, home health setting or managed care environment. **Preferred Qualifications:** + ... **Description** Care Manager RN - Utilization Review unit at Providence Queen...care. The RN Case Manager assists patients in the utilization of appropriate health care services. Position… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Proficient in application of clinical guidelines ... **Responsibilities** Responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the… 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 ... but not limited to: Skilled nursing facility, outpatient needs ( home health , physical therapy, infusion), and case...Utilization Management or CM. Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and… more
- CVS Health (Sacramento, CA)
- …authorization. + 5 years of a variety clinical experience required including acute care, home health , or long-term care. + 5 years demonstrated ability to make ... At CVS Health , we're building a world of health...call center environment. + 1 year of varied UM ( utilization management) experience within an inpatient, concurrent review… more
- CenterWell (Sacramento, CA)
- …Previous Medicare Advantage/Medicare + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health . + Bilingual **Use your skills to make an impact** ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- CenterWell (Sacramento, CA)
- …Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health . + Bilingual We offer tangible and intangible benefits such as ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- CenterWell (San Diego, CA)
- …available patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...insurance and many other opportunities. **About Us** About CenterWell Home Health : CenterWell Home … more
- Veterans Affairs, Veterans Health Administration (Mather, CA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... 401K with up to 5% in contributions by VA Insurance: Federal health /vision/dental/term life/long-term care (many federal insurance programs can be carried into… more
- Evolent (Sacramento, CA)
- …call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What ... **Your Future Evolves Here** Evolent Health has a bold mission to change the...Therapy you will be a key member of the utilization management team. We can offer you a meaningful… more