- Evolent (Sacramento, CA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- CVS Health (Sacramento, CA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Sutter Health (Sacramento, CA)
- …education to clinical staff and play an accountable role in supply management and utilization . **Job Description** : **EDUCATION:** Graduate of an accredited ... **Organization:** SCAH-Sutter Care at Home - Valley **Position Overview:** Serves as a clinical expert for wound, ostomy, and continence related issues to all … more
- Evolent (Sacramento, CA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Sutter Health (Sacramento, CA)
- …SMCS-Sutter Med Center - Sacramento **Position Overview:** The CVOR Nurse Manager provides leadership and operational oversight for the Cardiovascular ... distributions, and assists in meeting financial targets by effectively managing utilization , productivity, personnel, and supplies. Supports and educates staff in… more
- Sutter Health (Sacramento, CA)
- …in Healthcare (MPH, MHA, MS, MBA, etc.) **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California OR MD-Medical Doctor OR DO-Doctor of Osteopathy OR Foreign ... + CCS-Certified Coding Specialist within 1 year + CCDS-Certified Clinical Documentation Specialist OR CDIP-Certified Documentation Integrity Practitioner **TYPICAL… more
- Sacramento Behavioral Healthcare Hospital (Sacramento, CA)
- … management , group therapy, family & individual sessions. Psychiatrists, nurse practitioners, and internal medicine physicians comprise the provider group with ... Under the general direction of the Medical Director, the Psychiatrist provides clinical oversight. We are looking for a compassionate, experienced psychiatrist to… more
- Oracle (Sacramento, CA)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- Actalent (Sacramento, CA)
- …(eg, med-surg, telemetry, ICU) + At least 1 year of experience in utilization review, case management , or hospital discharge planning + Familiarity with ... Remote Licensed Vocational Nurse (LVN) Fully remote but MUST reside within...of the Sacramento area Job Duties + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and… more
- Highmark Health (Sacramento, CA)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more
- Dignity Health (Carmichael, CA)
- **Job Summary and Responsibilities** ** Nurse Manager of Care Coordination / Case Management ** **Sign On / Relocation Options** As our ** Nurse Manager Care ... goals and key performance metrics. These duties include: staff performance management , reviewing or gathering of data to promote performance improvement,… more
- Sutter Health (Sacramento, CA)
- …through close partnership with SMCS and service line leadership. Optimizing throughput, block utilization , asset management , and patient access with a focus on ... patient care. Establishes overall operating and capital budget with input from management team, ensuring financial targets are achieved and variances are addressed… more