- CVS Health (Sacramento, CA)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Highmark Health (Sacramento, CA)
- …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- CVS Health (Sacramento, CA)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... remote role open to candidates with an active RN licensure in the state in which they reside....to promote quality effectiveness of healthcare services and benefit utilization . **Required Qualifications** + Active and unrestricted RN… more
- Stanford Health Care (Palo Alto, CA)
- …on-call. **A Brief Overview** The Oncology Research Nursing Professional (ORNP) -is a Registered Nurse ( RN ) who works collaboratively with Clinical Research ... that facilitate Good Clinical Practice. o Contribute to elevating RN and APP practice in clinical research. o Provide...Practices training (can be completed after hire) + California Registered Nurse license + Basis Life Support… more
- Centene Corporation (Sacramento, CA)
- …benefits including a fresh perspective on workplace flexibility. + **This position requires RN California Licensure and for candidates to have a minimum of 1 year ... applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA… more
- Magellan Health Services (San Diego, CA)
- …Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... This is a remote position in California, candidates must be licensed...member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care… more
- Centene Corporation (Sacramento, CA)
- …preferred. Knowledge of utilization management processes preferred. **License/Certification:** + RN - Registered Nurse license required Pay Range: ... fresh perspective on workplace flexibility. **Must have an active California Registered Nurse license.** **Hours: Monday-Friday; 8am-5pm Pacific Standard… more
- Sharecare (Sacramento, CA)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Stanford Health Care (Palo Alto, CA)
- …active: + CCDS - Cert Clinical Document Spec . + CCDS-O or CDIP . + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred ... + ICU/ED and Academic Medical Center experience preferred. + Case management, utilization review and/or direct provider interaction experience, preferred. +… more
- Molina Healthcare (Oakland, CA)
- …Practical Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. ... Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state… more