- Evolent (Sacramento, CA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- The Cigna Group (Sacramento, CA)
- …outcomes, client growth and retention, and network performance. **OVERVIEW:** + The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and ... including medical cost driver analysis and action, complex case review , referral and engagement, account renewal consultation, and recommendations to positively… more
- Sacramento County (Sacramento, CA)
- Nurse Practitioner Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1780920) Apply Nurse Practitioner Salary $132,483.60 - $161,026.56 ... 9/26/2025, 10/24/2025, 11/26/25, 12/26/25, 1/23/26, 2/27/26, 3/27/26, 4/24/26, 5/22/26, 6/26/26 Nurse Practitioners provide a range of health care services involving… more
- Sacramento County (Sacramento, CA)
- …Interviewing techniques + Common current medical terminology + Use and care of medical equipment used in clinical and infirmary settings + Basic medical ... Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational Nurse D/CF Salary… more
- Sacramento County (Sacramento, CA)
- …Interviewing techniques + Common current medical terminology + Use and care of medical equipment used in clinical and infirmary settings + Basic medical ... Registered Nurse D/CF (Level I/II) Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II)… more
- CVS Health (Sacramento, CA)
- …year). There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all… more
- Actalent (Rancho Cordova, CA)
- Job Title: Utilization Review Nurse Job Description The Registered Nurse will review cases for medical necessity across all levels of care, ensuring ... that patients receive appropriate and necessary treatment. Responsibilities + Review medical cases for necessity at all...Additional Skills & Qualifications + Two years of strong clinical nursing experience, preferably as a floor nurse… more
- Sacramento Behavioral Healthcare Hospital (Sacramento, CA)
- …providers / obtain orders. + Performs medical clearance of DSH patients. + Provides Nurse to Nurse clinical information as well as to physician and ... POSITION TITLE: Assessment & Referrals (A&R) Registered Nurse REPORTS TO (TITLE): Director of Assessments &...core component of the role. Requirements KEY RESPONSIBILITIES: + Review packet referral for medical necessity following… more
- CenterWell (Sacramento, CA)
- …complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to ... to work every other holiday.** The **Care Manager, Telephonic Nurse ** helps to ensure optimal continuity of care for...Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services +… more
- BioLife Plasma Services (Sacramento, CA)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife ... of laboratory test results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works under the guidance of… more
- Datavant (Sacramento, CA)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Highmark Health (Sacramento, CA)
- …:** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job performs clinical review and data abstraction of patient records to support ... Preferred + Associate's or Bachelor's Degree in Nursing + 1 year performing medical record review and data abstraction for cardiovascular registries + Proficient… more
- Amergis (Sacramento, CA)
- …disability examinations for veterans in accordance with VBA guidelines. + Review medical records and document findings using standardized templates. ... We are seeking a compassionate anddetail-oriented Nurse Practitioner (NP) to join our team insupporting disabled veterans through the Veterans BenefitsAdministration… more
- Humana (Sacramento, CA)
- …effectively communicate a meaningful narrative with those findings + Proven ability to perform clinical reviews and review medical records + Ability to ... of our caring community and help us put health first** The Senior Clinical Medical /Financial Risk Evaluation Professional is responsible for supporting the… more
- CenterWell (Sacramento, CA)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Sacramento Behavioral Healthcare Hospital (Sacramento, CA)
- …with the patient (indicated by patient signatures, initials and dates that each review is completed). Oversees maintenance of patient clinical records and ... POSITION TITLE: Director of Clinical Services REPORTS TO: Chief Executive Officer (CEO)...patient care. Collaborates with Chief Executive Officer (CEO), Chief Nurse Office (CNO), and Director of Performance Improvement and… more
- Oracle (Sacramento, CA)
- …+ Excellent communication, stakeholder engagement, and leadership skills. **Preferred Qualifications:** + Clinical experience as a nurse or physician with a deep ... **Job Description** The Clinical Note AI Agent Product Management Leader will...Gather and analyze information to define product specifications and review design specifications. Envision and communicate product strategy and… more
- Maxim Healthcare (Sacramento, CA)
- …competency evaluations and provide education on new initiatives + Manage Novice Nurse Program, Skills Advancement Program, and student clinical rotations + ... Clinical Operations Specialist Location: Sacramento, CA Salary Range:...compliance initiatives + Lead quality improvement activities, including documentation review and data integrity + Assist with compliance, legal,… 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 ... + CCS-Certified Coding Specialist within 1 year + CCDS-Certified Clinical Documentation Specialist OR CDIP-Certified Documentation Integrity Practitioner **TYPICAL… more
- Molina Healthcare (Sacramento, CA)
- … medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial ... practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. *… more