- Actalent (Rancho Cordova, CA)
- …+ Strong computer skills. + Excellent communication skills. + Experience in utilization review , utilization management, prior authorization, case management, ... Prior Authorization RN FULLY REMOTE- MUST reside in California Great...healthcare to all Californians! Job Description The Prior Authorization Nurse will triage and review cases as… more
- Battelle Memorial Institute (San Diego, CA)
- …two years' nursing experience + Current, full, active, and unrestricted license as a Registered Nurse in any US State, the District of Columbia, Guam, Puerto ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report… more
- Actalent (Santa Barbara, CA)
- …+ Experience with HEDIS medical record abstraction. Additional Skills & Qualifications + Registered Nurse ( RN ) license. + Bilingual skills in Spanish ... Plan Nurse CoordinatorJob Description The Health Plan Nurse Coordinator is a Registered Nurse...community standards, and professional nursing standards. Essential Skills + Utilization management and review experience. + Strong… more
- Highmark Health (Sacramento, CA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). + Delaware RN license must be obtained within… more
- STG International (Victorville, CA)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. ... patient safety. *Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health… more
- Deloitte (Los Angeles, CA)
- …Bachelor's degree in nursing, medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical ... nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN , Quality, DRG Validation and… more
- KBR (San Diego, CA)
- …compliance in meeting care goals. * Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... the electronic medical records of all patients contacted for review by the managing physician; Routinely staffs difficult cases... license; full, active, and unrestricted license as a Registered Nurse in one of any US… more
- Centene Corporation (Sacramento, CA)
- …management principles preferred. 25% Travel CA RN License Required **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review … more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …an accredited school of professional nursing. Must maintain current license as a Registered Nurse , Master's degree preferred. + Minimum of 3 years' experience ... knowledge and skills in areas of risk management, infection control, and utilization review . + Current knowledge of continuous quality improvement methodology.… more
- KBR (San Diego, CA)
- …compliance in meeting care goals. * Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... Clearance, or the ability to obtain a clearance. * Current RN license; full, active, and unrestricted license as a Registered Nurse in one of any US State,… more