Current jobs related to Utilization Management Nurse - Rancho Cordova - Actalent
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Utilization Management Nurse Senior
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly skilled Utilization Management Nurse to join our team at Blue Shield of California. As a key member of our Utilization Management team, you will play a critical role in ensuring that our members receive the most appropriate and cost-effective care.Key ResponsibilitiesConduct thorough reviews of inpatient stays to...
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Senior Utilization Management Nurse
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeYour RoleAs a Senior Utilization Management Nurse at Blue Shield of California, you will play a critical role in ensuring the quality and cost-effectiveness of healthcare services for our members.Key ResponsibilitiesConduct thorough reviews of inpatient stays to determine medical necessity and ensure compliance with nationally recognized...
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Senior Nurse for Utilization Management
2 months ago
Rancho Cordova, California, United States Blue Shield of California Full timePosition OverviewThe Utilization Management department is responsible for evaluating inpatient admissions for our members, adhering to established standards of care. The Senior Utilization Management Nurse will work under the guidance of the Utilization Management Nurse Manager. This role involves assessing clinical data from various inpatient facilities to...
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Senior Utilization Management Nurse
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeYour RoleAs a Utilization Management Nurse, you will play a critical role in ensuring that our members receive the highest quality care while minimizing unnecessary costs. You will be responsible for reviewing inpatient stays and applying nationally recognized levels of care guidelines to determine medical necessity.Your WorkConduct thorough reviews of...
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Utilization Management Nurse, Senior
1 month ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse, Senior will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical...
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Utilization Management Nurse, Senior
1 month ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse, Senior will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical...
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Medical Policy Utilization Management Nurse
2 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeJob SummaryAs a Medical Policy Utilization Management Nurse, you will play a critical role in ensuring the quality and cost-effectiveness of healthcare services for our members. You will be responsible for conducting clinical reviews of claims to determine medical necessity, coding accuracy, and compliance with medical policies and contracts.Key...
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Senior Utilization Management Nurse
2 months ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleThe Utilization Management Nurse, Senior will play a critical role in ensuring the quality and appropriateness of care for our members. As a key member of the Utilization Management team, you will be responsible for reviewing inpatient stays to determine medical necessity and level of care.Key ResponsibilitiesPerform prospective utilization...
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Utilization Management Nurse, Senior
1 month ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information...
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Utilization Management Nurse, Senior
2 months ago
Rancho Cordova, United States Blue Shield Of California Full timeYour Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information...
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Utilization Management Nurse, Senior
2 months ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information...
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Utilization Management Nurse, Senior
3 weeks ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information...
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Utilization Management Nurse, Senior
2 weeks ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information...
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Utilization Management Nurse, Senior
2 months ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information...
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Utilization Management Nurse, Senior
3 weeks ago
Rancho Cordova, United States Blue Shield of California Full timeYour RoleThe Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information...
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Utilization Management Nurse Senior
3 weeks ago
Rancho Cordova, California, United States Blue Shield Of California Full timeAbout the RoleWe are seeking a highly skilled Utilization Management Nurse, Senior to join our team at Blue Shield of California. As a key member of our Utilization Management team, you will play a critical role in ensuring our members receive high-quality, cost-effective care.Key ResponsibilitiesPerform prospective utilization reviews and first-level...
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Utilization Management Nurse Senior CalPERS
4 weeks ago
Rancho Cordova, California, United States Blue Shield Of California Full timeJob Title: Utilization Management Nurse, Senior CalPERSAt Blue Shield of California, we are committed to ensuring all Californians have access to high-quality healthcare at a sustainably affordable price. We are seeking a skilled Utilization Management Nurse, Senior CalPERS to join our team.About the RoleThe Commercial Post Service Review team is responsible...
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Senior Utilization Management Nurse
2 weeks ago
Rancho Cordova, California, United States Blue Shield Of California Full timeJob SummaryThe Senior Utilization Management Nurse will be responsible for reviewing inpatient stays for our members under nationally recognized levels of care guidelines. This role requires a strong clinical background and excellent analytical skills to determine medical necessity of admissions, appropriate length of stay, and level of care.Key...
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Utilization Management Nurse, Senior
2 weeks ago
Rancho Cordova, California, United States Blue Shield Of California Full timeAbout the RoleThe Utilization Management Nurse, Senior will play a critical role in ensuring the quality and cost-effectiveness of healthcare services for our members.Key ResponsibilitiesConduct prospective, concurrent, and retrospective utilization reviews to determine medical necessity and ensure compliance with nationally recognized clinical...
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Senior Utilization Management Nurse
1 week ago
Rancho Cordova, California, United States Blue Shield Of California Full timeJob SummaryThe Senior Utilization Management Nurse will be responsible for performing first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medicare. This role requires a strong clinical judgment and...
Utilization Management Nurse
2 months ago
Description: Responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic Medical Group through an interdisciplinary process that provides a clinical and financial approach through the continuum of care. Promotes the quality and cost effectiveness of medical care by ensuring department staff are applying clinical acumen and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision, this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory guidelines. Responsible for day to day operations of the Pre-Authorization team to include timely response and appropriate evaluation of referral reviews, correct selection of criteria, accurate prep to the UM Physician reviewer when indicated, timely verbal and written documentation, and completion of the file Skills: Utilization review, Case management, Acute care, Prior authorization, Interqual, Concurrent review, Discharge planning, Epic Additional Skills & Qualifications: CA RN License Five or more year's clinical experience required. Three to five years Utilization Management experience required. One to three years charge/lead/supervisory/management experience required. Ablility to demonstrate leadership and management skills. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through: Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our people The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.
