Utilization Manager Jobs in Rancho Cordova
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Search Results - Utilization Manager Jobs in Rancho Cordova
Blue Shield of California-Rancho Cordova
Your Role
Reporting to the Sr. Director, Utilization Management, the role of the Director, Medicare & Medi-Cal Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its...
Rancho Cordova
leading up to or including supervisory role
• Experience in Utilization Management Case Management or Care Coordination Managed Care is preferred
Required Minimum Knowledge, Skills and Abilities:
• Knowledge of current nursing technique, principles...
icims.com -
Blue Shield of California-Rancho Cordova
Your Role
Reporting to the Sr. Director, Utilization Management, the role of the Director, Commercial Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals...
Blue Shield of California-Rancho Cordova
Your Role
The Utilization Management team reviews the inpatient stays for our members under the guidelines for nationally recognized levels of care. The Utilization Management Nurse, Senior will report to the Utilization Management Nurse Manager...
Blue Shield of California-Rancho Cordova
Your 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...
Blue Shield of California-Rancho Cordova
will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the areas of psychiatric inpatient concurrent review, pre- and post-service utilization review, and collaboration with Nurse Care Managers.
Your...
Blue Shield of California-Rancho Cordova
pre and post service utilization review, and collaboration with RN Care Managers. The Senior Medical Director, Behavioral Health will serve as clinical, regulatory and quality improvement resource and clinical behavioral health thought leader within...
Blue Shield of California-Rancho Cordova
metrics.
• Process Faxed /Web Portal /Phoned in Prior Authorization or Hospital Admission Notification Requests, Utilization Management (UM)/Case Management (CM) requests and/or calls left on voicemail.
• Select support for Case Manager such as mailings...
Blue Shield of California-Rancho Cordova
Your Role
The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical...
Blue Shield of California-Rancho Cordova
years managed care experience preferred.
• Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources preferred
• Behavioral health, oncology, or OB/NICU/pediatrics experience...
Blue Shield of California-Rancho Cordova
procedures and practices.
Your Knowledge and Experience
• Current CA RN License.
• Bachelors of Science in Nursing or advanced degree preferred.
• At least 10 years of prior relevant experience in health plan.
• Utilization Management experience highly...
Blue Shield of California-Rancho Cordova
perform a blended function of utilization management (UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating...
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