- Sutter Health (Roseville, CA)
- …school of nursing + Bachelor's in Nursing preferred. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** + ... case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of… more
- Highmark Health (Sacramento, CA)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sutter Health (Sacramento, CA)
- …+ Other: Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California OR CNS-Clinical Nurse Specialist ... internally and externally, including clinical and support staff, other departments, management , Sutter Health clinical nurse educators, college staff, regional… more
- Sutter Health (Sacramento, CA)
- …**EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** ... barriers to patient care they experience with the SNFs. Utilization Management . * Reviews medical record to... within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- Centene Corporation (Sacramento, CA)
- …Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + For Health ... California RN Licensure. **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine if the level of care… more
- Centene Corporation (Sacramento, CA)
- …Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + For Health ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Sacramento, CA)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + For Health ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Dignity Health (Rancho Cordova, CA)
- …3 years in a Care Coordination or Case Manager role. - Clear and current CA Registered Nurse ( RN ) license. - Associate Degree in Nursing (ADN) or Bachelors ... efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality… more
- County of El Dorado (Placerville, CA)
- …Counselors. They will have experience in providing SUD services and performing Quality Management and/or Utilization Review activities. They would have ... Family Therapist (LMFT), a Licensed Professional Clinical Counselor (LPCC), a Clinical Psychologist, or Registered Nurse ? Required for IB/II + Yes + No 03 If you… more
- Sutter Health (Sacramento, CA)
- …**EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** ... System Office-Valley **Position Overview:** Manages the operations of the centralized Utilization review department for Sutter Health entities in accordance… more
- Insight Global (Sacramento, CA)
- …is being delivered Participates in the Outcomes Management and annual program review Performs utilization review of continuous care and inpatient levels ... Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills and Requirements 2+ year management exp 3+ year RN experience hospice home… more
- Sharecare (Sacramento, CA)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... members of the health care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager. All Sharecare clinicians… more
- Cardinal Health (Sacramento, CA)
- …and service education to facilitate technology adoption and workflow change management . + Demonstrates extensive knowledge and understanding of relevant clinical ... best demonstrated practices + Significantly influences customer acceptance and utilization of new products and services in multi-site and/or...of the time + Bachelor's degree preferred + Current RN license preferred + 6-8 years of experience in… more