- 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
- Sutter Health (Roseville, 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
- Sutter Health (Concord, CA)
- …standards of practice Fiscal Responsibility (includes productivity, HHRG rating, supply management , utilization review ) * Demonstrates ability to ... Care at Home - Bay **Position Overview:** Under the general direction of a qualified registered nurse , the Licensed Vocational Nurse assists in the nursing… more
- Sutter Health (Sacramento, CA)
- …+ Other: Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California OR CNS-Clinical Nurse Specialist ... internally and externally, including clinical and support staff, other departments, management , Sutter Health clinical nurse educators, college staff, regional… more
- Sutter Health (Sacramento, CA)
- …**EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** ... barriers to patient care they experience with the SNFs. Utilization Management . * Reviews medical record to... within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- Centene Corporation (Sacramento, CA)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + For Health ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… 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
- 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 ... Family Therapist (LMFT), a Licensed Professional Clinical Counselor (LPCC), a Clinical Psychologist, or Registered Nurse ? Required for IB/II + Yes + No 03 If you… more
- Veterans Affairs, Veterans Health Administration (Mather, CA)
- … of the EDRP application. Former EDRP participants ineligible to apply. Responsibilities The Registered Nurse - Nurse Manager (Patient Care Services) is ... to ensure comprehensive patient care. Responsible to ensure monitoring utilization of supplies for cost control and overall efficiency....level degree in Nursing may have opportunity to become registered as a nurse with a state… 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
- Dignity Health (San Andreas, CA)
- …of patient satisfaction. The RN Care Coordinator consistently conducts the utilization review process and the discharge planning process as required by ... of dignity collaboration justice stewardship and excellence. **Responsibilities** The RN Care Coordinator is responsible for assessing planning facilitating and… more
- Sutter Health (Sacramento, CA)
- …**EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** ... System Office-Valley **Position Overview:** Manages the operations of the centralized Utilization review department for Sutter Health entities in accordance… more
- Elevance Health (Walnut Creek, CA)
- …on relatively complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians. **How you will ... or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or … 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
- Elevance Health (Walnut Creek, CA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… 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