- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
- Evolent (Sacramento, CA)
- …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
- LA Care Health Plan (Los Angeles, CA)
- …least 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting, At least 2 years in ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department:...position will mentor, coach, and may provide feedback to management on performance of staff. Ensure team effectiveness and… more
- LA Care Health Plan (Los Angeles, CA)
- …least 9 years of experience in health plan operations, managed care, A&G, utilization management , clinical operations, or regulatory compliance. At least 8 years ... Senior Director and Grievance Officer, Appeals and Grievances Job Category: Management /Executive Department: CSC Appeals & Grievances Location: Los Angeles,… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** Other; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** ... care. **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse (LVN) - CA… more
- Sutter Health (Sacramento, CA)
- …manner to insurance case management providers to assure continued and discharge utilization management appeals to patient care needs. **Job Description** ... Health! **Organization:** SCP-Sutter Center for Psychiatry **Position Overview:** The Utilization Review/Discharge Planner (UR/DP) performs chart review to determine… more
- Cedars-Sinai (CA)
- …reporting to the TPL carrier of all injured worker cases receiving case management services. + Ensures appropriate utilization of medical services within the ... Doing** The Case Manager is responsible for the case management of patient while hospitalized and upon discharge from...of care. Use evidence based review guidelines to conduct utilization review as is appropriate to match the payor… more
- Sharp HealthCare (La Mesa, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... as Allscripts.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- LA Care Health Plan (Los Angeles, CA)
- …quality, and regulatory interpretation. The role ensures strong collaboration with Utilization Management , the UM Medical Director, physician reviewers, ... Senior Manager, Clinical and Regulatory Operations Job Category: Management /Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more