- CVS Health (Sacramento, CA)
- …1 holiday per year). There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... we do it all with heart, each and every day. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is fully remote but must reside in… more
- CVS Health (Sacramento, CA)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CenterWell (Sacramento, CA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CVS Health (Sacramento, CA)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in PST zones **Education**… more
- Actalent (Rancho Cordova, CA)
- …ensure quality review. + Collaborate with healthcare teams to facilitate effective utilization management . + Employ MCG criteria and electronic medical records ... Job Title: Utilization Review Nurse Job Description The... or in direct patient care. + Experience in utilization management is a plus but not… more
- Evolent (Sacramento, CA)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… 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)
- …continence education to clinical staff and play an accountable role in supply management and utilization . **Job Description** : **EDUCATION:** Graduate of an ... all clinical and administrative staff in their location. Provides oversight and management to wound, ostomy and continence patients through digital and in-home… more
- Molina Healthcare (Sacramento, CA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… 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 ... rules, Joint Commission requirements, and legal regulations; participating in utilization reviews; and remaining available for emergency consultations. + Improves… more
- Sharecare (Sacramento, CA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… 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 ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… 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
- CVS Health (Sacramento, CA)
- …health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care, ... education, connecting members to resources, and facilitating referrals to care management programs for continued support. This position supports the development and… 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
- Sutter Health (Roseville, CA)
- …team to implement the established plan of patient care and ensuring effective management of visit utilization and control of expenses. May assist in ... Valley **Position Overview:** An experienced RN who is responsible for the overall management of patients, including the provision of direct care with a designated… more
- Oracle (Sacramento, CA)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… 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 ... Documentation Integrity Practitioner **TYPICAL EXPERIENCE:** + 5 years recent management experience **SKILLS AND KNOWLEDGE:** + Knowledge of Pathophysiology and… more