- 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...Hospital offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Evolent (Sacramento, CA)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health ... care, we seek to connect the pieces of fragmented health care system and ensure people get the same...and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved… more
- Evolent (Sacramento, CA)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health ... care, we seek to connect the pieces of fragmented health care system and ensure people get the same...in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a… 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
- Providence (Napa, CA)
- **Description** Social Worker MSW in Utilization Review Unit at Queen of the Valley Medical Center, CA. This position is Full time and will work 8-hour Day ... Full time **Job Shift:** Day **Career Track:** Clinical Professional **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work… more
- Evolent (Sacramento, CA)
- …to adeptly negotiate internally and externally around interpretation and application of utilization review law, accreditation standards and policy. + Ensures ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health … more
- Humana (Sacramento, CA)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health insurance ... **Become a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The… 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 ... focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance… more
- HCA Healthcare (Riverside, CA)
- …Nurse (RN) with current California license required, Case Management Certification or utilization review preferred + Associate's Degree minimum required + ... Riverside Community Hospital offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- Evolent (Sacramento, CA)
- …HIPAA, provider and vendor contracting, compliance, population health (including utilization management), Medicare, and Medicaid. + Draft, review and ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...President, Deputy General Counsel, the Attorney will prepare and review a variety of complex contracts and provide legal… more