- CVS Health (Sacramento, CA)
- …Work schedules may include weekends and holidays and evening rotations._ As a Utilization Management Nurse Consultant, you will utilize clinical skills ... Qualifications** - 3+ years of experience as a Registered Nurse - Must have active current and unrestricted RN...clinical experience in acute or post acute setting - Utilization management is a 24/7 operation. Work… more
- Actalent (Rancho Cordova, CA)
- …Five or more year's clinical experience required. Three to five years Utilization Management experience required. One to three years charge/lead/supervisory/ ... timely verbal and written documentation, and completion of the file Skills: Utilization review, Case management , Acute care, Prior authorization, Interqual,… more
- Lincoln Financial Group (Sacramento, CA)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Centene Corporation (Sacramento, CA)
- …levels of care and facilities + Partners with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners ... and actions taken on member medical records in health management systems according to utilization management... processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required Pay Range: $29.43 -… more
- Molina Healthcare (Sacramento, CA)
- **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, ... are most receptive including home, nursing facilities, and "pop up" clinic. The Nurse Practitioner will be required to work primarily in non-clinical settings and… more
- Sutter Health (Sacramento, CA)
- …care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely ... of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through… more
- Dignity Health (Carmichael, CA)
- …Excellence in Perinatal Care Hip- and Knee- Replacement. **Responsibilities** **Emergency Services Nurse Manager** Mercy San Juan Medical Center, a member of Dignity ... Health/Commonspirit Health, is looking for a strong Emergency Services Nurse Manager who enjoys a busy, multi-faceted team-oriented emergency department environment.… more
- Sutter Health (Sacramento, CA)
- **Organization:** SCP-Sutter Center for Psychiatry **Position Overview:** The Registered Nurse in the Mental Health setting manages the patient/family experience ... through utilization of critical thinking, teamwork, effective communication, and nursing...accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN-Registered Nurse for the state where care is provided +… more
- Sacramento Behavioral Healthcare Hospital (Sacramento, CA)
- …and treatment methods, with specific knowledge and skills in areas of risk management , infection control, and utilization review. + Current knowledge of ... school of professional nursing. Must maintain current license as a Registered Nurse , Master's degree preferred. + Minimum of 3 years' experience with specific… more
- Actalent (Rancho Cordova, CA)
- …Skills: Acute Care, Concurrent Review, Home Health, Long Term care, Health plan, Utilization Review, Utilization Management , Interqual Additional Skills & ... intervenes or as clinically appropriate + Provides referrals to Case Management , Disease Management , Appeals and Grievance and Quality Departments as necessary +… more
- Molina Healthcare (Sacramento, CA)
- …seeking a LVN (Licensed Vocational Nurse ) with experience in Prior Authorizations, Utilization Review / Utilization Management and knowledge of Interqual ... 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association** Active,… more
- Molina Healthcare (Sacramento, CA)
- … Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual ... Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
- Highmark Health (Sacramento, CA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... Experience in a clinical setting **Preferred** + Certification in utilization management or a related field +...Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** + Working knowledge of… more
- Molina Healthcare (Sacramento, CA)
- …to a 3 day/12 hour shift from then on._** **_Previous experience with Emergency Room Utilization Management / Utilization Review is required for this role. ... **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_PERMANENT SHIFT WILL BE :_** **_12 hour...or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current… 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, Inc. (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
- Edwards Lifesciences (Sacramento, CA)
- …impact by ** + Working independently in the areas of valve crimping, case management , pre-case planning, post-case management , 3 Mensio management , Therapy ... implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential customers… more
- Sedgwick (Sacramento, CA)
- …and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review. **Skills & Knowledge** + ... providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** +… more
- Sutter Health (Sacramento, 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
- Sutter Health (Roseville, CA)
- …manages capital and operational budgets to achieve financial targets via effective utilization of personnel, resources and supplies. Develops and maintains a solid ... of nursing. + **MSN** **_preferred_** **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California + BLS-Basic Life Support Healthcare Provider **TYPICAL… more