- 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
- 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
- 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
- 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 ... At CVS Health , we're building a world of health...be required. This position will be remote working from home anywhere in the US. **Position Summary** + Utilizes… 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
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for ... Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format**… 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