- Centene Corporation (Sacramento, CA)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- Centene Corporation (Sacramento, CA)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... position that requires a CA RN Licensure.** **Position Purpose** : Performs concurrent reviews, including determining member's overall health, reviewing the type of… more
- Sutter Health (Sacramento, CA)
- …Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California OR CNS- Clinical Nurse Specialist + BLS-Basic ... health plan/medical group payor experience, specifically with prior authorization and/or concurrent review ** + **Understand Medicare and DMHC plan/payor… more
- Elevance Health (Rancho Cordova, CA)
- …plans will require guidance from leadership, medical directors or delegated clinical staff. + Conducts pre-certification, concurrent , retrospective, out of ... not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians....equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. +… more
- Dignity Health (Rancho Cordova, CA)
- … clinical social work and best practice in medical necessity determination and concurrent review . This position will supervise the department in an efficient ... manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality patient care. The… more