- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Baylor Scott & White Health (Sacramento, CA)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Dignity Health (Woodland, CA)
- …- Three (3) years acute care or related experience including experience in case management utilization review or discharge planning. - Clear and current ... identified assists the patient family caregiver care coordination with Utilization management as related to referrals. -...CA RN license. **Preferred Qualifications:** - Concurrent review … more
- Sutter Health (Davis, 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
- Sharecare (Sacramento, CA)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Highmark Health (Sacramento, CA)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… 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
- Guardian Life (Sacramento, CA)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Centene Corporation (Sacramento, CA)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + For Health… more
- ICW Group (Sacramento, CA)
- …providing direct clinical care required. **CERTIFICATES, LICENSES, REGISTRATIONS** Current unrestricted Registered Nurse ( RN ) or Licensed Vocational ... + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance...Nurse (LVN) required. Certification in case management , rehabilitation nursing or a related specialty is strongly… more
- Elevance Health (Rancho Cordova, CA)
- …relatively complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians. Approval decisions ... initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes....a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid… 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