- Evolent (Sacramento, CA)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Services As Needed / ... **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- Providence (Napa, CA)
- **Description** Care Manager RN - Utilization Review unit at Providence Queen of the Valley Medical Center in Napa, CA. This position is Full-Time and will ... or outpatient case management setting + Upon hire: California Registered Nurse License + 2 years Case...time **Job Shift:** Day **Career Track:** Nursing **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas… more
- LA Care Health Plan (Los Angeles, CA)
- …requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Utilization Management Admissions Liaison RN II...Management Medical Director, on requests where determination requires extended review . Collaborates with the inpatient care team for facilitation/coordination… more
- CVS Health (Sacramento, CA)
- …demonstrated ability to make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted license in their state ... UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience… more
- Prime Healthcare (Chino, CA)
- …experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 ... among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… more
- Prime Healthcare (San Dimas, CA)
- …experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… more
- LA Care Health Plan (Los Angeles, CA)
- …Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and ... Managed Long Term Services and Supports Nurse Specialist RN II Job Category:...home care, palliative care, hospice care OR experience in Utilization Review or Care Management will be… more
- LA Care Health Plan (Los Angeles, CA)
- …of Microsoft Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Payment Integrity Nurse Coder RN III Job Category:...policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management… more
- Centene Corporation (Sacramento, CA)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare… more