Current jobs related to Utilization Review Nurse - Sacramento - A-Line Staffing Solutions
-
Assistant Project Manager
2 weeks ago
Sacramento, California, United States AECOM Full timeJob SummaryUnder the general direction of the Project Manager – Reports of Investigation and the Utilities Senior Project Manager, the Utility Design Reviewer contributes to a team of Utility Design Reviewers to prepare, review, coordinate, and track all utility Reports of Investigation for the client.Key ResponsibilitiesReview utility relocation design...
-
Sacramento, California, United States AECOM Full timeJob SummaryAECOM is seeking a highly skilled Assistant Project Manager Utility Design Reviewer to join our team. As a key member of our Utility Design Review team, you will be responsible for reviewing and coordinating utility designs to ensure compliance with client requirements.Key ResponsibilitiesReview utility relocation design plans and right-of-way...
-
Assistant Project Manager
2 weeks ago
Sacramento, California, United States AECOM Full timeJob SummaryAECOM is seeking an experienced Utility Design Reviewer to join our team in Sacramento or Fresno, CA. As an Assistant Project Manager, you will contribute to the preparation, review, and coordination of utility Reports of Investigation for our client.Key ResponsibilitiesReview utility relocation design plans and right-of-way maps to ensure...
-
Clinical Review Nurse
4 weeks ago
Sacramento, California, United States Centene Corporation Full timeJob Title: Senior Clinical Review NurseJoin Centene Corporation, a leading healthcare company, as a Senior Clinical Review Nurse. In this role, you will play a critical part in ensuring our members receive high-quality, medically necessary care.Job Summary:We are seeking a highly skilled and experienced Senior Clinical Review Nurse to join our Medical...
-
Sacramento, United States Benefit & Risk Management Services, Inc. Full timeJob DescriptionJob DescriptionSummary: The Care Management Utilization Review Coordinator supports the Care Management Department with both prospective and retrospective authorization requests.Essential Duties and Responsibilities include but are not necessarily limited to the following. Other duties may be assigned.Must be able to work 8:30 am to 5 pm,...
-
RN Clinical Review Nurse
2 days ago
Sacramento, United States Centene Corporation Full timeYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Fully Remote position that requires a CA RN Licensure. Position Purpose...
-
Utilization Management Coordinator
2 weeks ago
Sacramento, California, United States Universal Health Services Full timeJob Title: Utilization Management CoordinatorSierra Vista Hospital is seeking a dedicated and experienced Utilization Management Coordinator to join our team. As a key member of our Utilization Management Department, you will play a vital role in ensuring the effective management of patient resources and maximizing the quality of care.Responsibilities:Manage...
-
Utilization Management Specialist
3 weeks ago
Sacramento, California, United States Universal Health Services Full timeJob SummaryWe are seeking a highly skilled Utilization Management Coordinator to join our team at Sierra Vista Hospital. As a key member of our Utilization Management Department, you will play a critical role in ensuring the effective management of patient resources and maximizing the quality of care.ResponsibilitiesManage and review patient utilization of...
-
Clinical Utilization Manager
2 weeks ago
Sacramento, California, United States Universal Health Services Full timeJob Title: Clinical Utilization ManagerAt Universal Health Services, we are seeking a highly skilled Clinical Utilization Manager to join our team. As a key member of our multidisciplinary treatment team, you will play a critical role in promoting positive outcomes and optimal reimbursement through coordination of patient care, daily clinical reviews,...
-
Utilization Management Nurse Consultant
2 weeks ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to coordinate, document,...
-
Clinical Utilization Specialist
4 weeks ago
Sacramento, California, United States Universal Health Services Full timeJob Title: Utilization Management CoordinatorAt Heritage Oaks Hospital, we are seeking a highly skilled Utilization Management Coordinator to join our team. As a key member of our multidisciplinary treatment team, you will play a critical role in ensuring that our patients receive the highest level of care while promoting positive outcomes and optimal...
-
Utilization Management Nurse Consultant
3 weeks ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our healthcare team, you will play a vital role in ensuring that our members receive the most appropriate care at the right time and in the right location.Key ResponsibilitiesUtilize clinical expertise to coordinate and document all aspects...
-
Clinical Utilization Management Specialist
2 months ago
Sacramento, California, United States Universal Health Services Full timeJob SummaryWe are seeking a highly skilled Clinical Utilization Management Specialist to join our team at Universal Health Services. As a key member of our multidisciplinary treatment team, you will play a critical role in ensuring the optimal utilization of healthcare resources while promoting positive patient outcomes.Key ResponsibilitiesTimely Clinical...
-
Clinical Resources Nurse
7 days ago
Sacramento, California, United States Western Health Advantage Full timeJob DescriptionWestern Health Advantage is seeking a skilled Clinical Resources Nurse to join our team. As a key member of our Utilization Management department, you will play a critical role in ensuring that our members receive the highest quality care while also meeting the needs of our health plan.Key Responsibilities:Perform research and evaluation of...
-
Clinical Utilization Manager
2 weeks ago
Sacramento, California, United States Universal Health Services Full timeJob Title: Clinical Utilization ManagerHeritage Oaks Hospital, part of the Universal Health Services (UHS) family, is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our multidisciplinary treatment team, you will play a vital role in ensuring optimal patient care and reimbursement.Responsibilities:Conduct daily clinical...
-
Utilization Management Coordinator
2 weeks ago
Sacramento, California, United States Sierra Vista Hospital Full timeJob SummarySierra Vista Hospital is seeking a skilled Utilization Management Coordinator to join our team. As a key member of our Utilization Management Department, you will play a vital role in ensuring the efficient use of resources and maximizing patient care.ResponsibilitiesManage and review patient records to ensure clinical appropriateness and maximize...
-
Utilization Management Coordinator
4 weeks ago
Sacramento, California, United States Sierra Vista Hospital Full timeJob Title: Utilization Management CoordinatorAbout the Role:Sierra Vista Hospital is seeking a highly skilled Utilization Management Coordinator to join our team. As a key member of our Utilization Management Department, you will play a critical role in ensuring the effective management of patient resources and maximizing the quality of...
-
Clinical Utilization Management Specialist
3 days ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Nurse Consultant to join our team in the Utilization Management department. As a key member of our team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right location.Key Responsibilities Utilize clinical expertise to coordinate, document,...
-
Clinical Utilization Management Specialist
2 weeks ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our healthcare team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to coordinate, document, and...
-
Healthcare Utilization Manager
2 days ago
Sacramento, California, United States DirectEmployers Full timeAt DirectEmployers, we are seeking a skilled and experienced Healthcare Utilization Manager to join our team. As a key member of our team, you will play a vital role in ensuring the quality and cost-effectiveness of healthcare services for our members.The ideal candidate will have a strong background in nursing, with at least 3 years of experience in...
Utilization Review Nurse
2 months ago
A-Line staffing is hiring a Fully Remote Concurrent Review Nurse in California
If interested APPLY NOW for IMMEDIATE consideration
Concurrent Review Nurse Details:
- Location: 100% Fully Remote – must live in state of California
- Schedule: Monday-Friday 8:00am-5:00pm PST
Concurrent Review Nurse Compensation
- The pay for this position is $40-$42 per hour based on experience
- Benefits are available to full-time employees after 90 days of employment
- A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates
Concurrent Review Nurse Qualifications:
- Active RN license in the state of California
- Must reside in California
- 2-4 years of hospital, managed care, UM experience required
- Knowledge of healthcare and managed care preferred
- Knowledge of Medicare and Medicaid Utilization Review processes
- Must have solid computer skills
- Experience with computer operating systems; Microsoft Systems, experience with TruCare is beneficial.
Concurrent Review Nurse Responsibilities:
Summary: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.
· Perform review of concurrent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director for secondary review.
· Complete medical necessity and level of care reviews for requested services using InterQual guidelines and refer to Medical Directors for review depending on case findings.
· Collaborate with various staff within provider networks and discharge planning team electronically and telephonically to coordinate member care.
· Conduct discharge planning. Educate providers on utilization and medical management processes.
· Provide clinical knowledge and act as a clinical resource to non-clinical team staff.
· Enter and maintain pertinent clinical information in various medical management systems.
If interested APPLY NOW to Silvana Manzella for IMMEDIATE consideration
