- Humana (Sacramento, CA)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Sutter Health (Sacramento, CA)
- …internally and externally, including clinical and support staff, other departments, management , Sutter Health clinical nurse educators, college staff, regional ... identified learning needs, department goals, quality improvement measures, risk management , regulatory changes, and compliancy criteria. Designs educational offerings… 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
- Veterans Affairs, Veterans Health Administration (Mather, CA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The Registered Nurse - Nurse Manager (Patient Care Services)...to ensure comprehensive patient care. Responsible to ensure monitoring utilization of supplies for cost control and overall efficiency.… more
- Sutter Health (Roseville, CA)
- …case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of ... management , quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers… more
- Sutter Health (Sacramento, CA)
- …System Office-Valley **Position Overview:** Manages the operations of the centralized Utilization review department for Sutter Health entities in accordance ... technical development)._ **JOB ACCOUNTABILITIES:** Effectively manages the activities of the utilization review team, providing leadership and guidance *… more
- Sutter Health (Sacramento, CA)
- …team to identify any barriers to patient care they experience with the SNFs. Utilization Management . * Reviews medical record to ensure patient continues to meet ... case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of… more
- Evolent (Sacramento, CA)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Evolent (Sacramento, CA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Elevance Health (Rancho Cordova, CA)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians....initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes.… more
- Dignity Health (Rancho Cordova, CA)
- …efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality ... day departmental operations including, but not limited to: clinical resource management , discharge planning activities, patient advocacy, clinical social work and… 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 ... and Human Services, Behavioral Health Department, located in Placerville, CA. QUALITY MANAGEMENT UNIT IDEAL CANDIDATE STATEMENT: The ideal candidate for the Quality … more