- Cognizant (Sacramento, CA)
- …Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,...Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan +… more
- Actalent (Rancho Cordova, CA)
- Utilization Review Nurse About the Role We're looking for a Utilization Review (UR) Nurse to join our team and support high‑quality, ... cost‑effective patient care from a fully remote environment. This role is ideal for nurses who...ensure appropriate levels of care. Key Responsibilities + Conduct utilization reviews for inpatient, outpatient, and ancillary services using… more
- CVS Health (Sacramento, CA)
- …with heart, each and every day. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is fully remote but must reside in PST zone.** ... cardiology **Preferred Qualifications** -1+ years' experience in either Precertification or Utilization Review -1+ years' experience Managed Care -Strong… more
- Providence (Irvine, CA)
- **Description** **RN Utilization Review at Irvine, CA. This position is Full- time and will work Remote 8-hour, Day shifts.** Provide prospective, ... retrospective, and concurrent utilization reviews for our Southern CA ministries. Conduct clinical...for our Southern CA ministries. Conduct clinical reviews and review medical records daily during admission for all payers,… more
- Providence (Mission Hills, CA)
- …time **Job Shift:** Multiple shifts available **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi ... **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records… more
- Actalent (Rancho Cordova, CA)
- Job Title: Utilization Review Nurse Job...+ Work independently and within a team in a remote setting. Essential Skills + Acute care and inpatient ... Description The Registered Nurse will review cases for medical necessity across all levels of.... + Collaborate with healthcare teams to facilitate effective utilization management. + Employ MCG criteria and electronic medical… more
- Evolent (Sacramento, CA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Providence (CA)
- …in a medical record. + 2 years - HEDIS, Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and pharmacy records… more
- Stanford Health Care (Palo Alto, CA)
- …+ ICU/ED and Academic Medical Center experience preferred. + Case management, utilization review and/or direct provider interaction experience, preferred. + ... Clinical Document Spec . + CCDS-O or CDIP . + Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred . **These principles apply to… more
- Actalent (Sacramento, CA)
- Remote Licensed Vocational Nurse (LVN) Fully...ICU) + At least 1 year of experience in utilization review , case management, or hospital discharge ... within 50 miles of the Sacramento area Job Duties + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and discharges + Apply CMS… more