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
The Medical Care Solutions education team is responsible for all clinical education for all departments within Medical Care Solutions as well as some Health Solutions teams. This includes Utilization Management, Care Management, Post...
Rancho Cordova
regulations, and guidelines as it relates to clinical education and training. Deveolpes appropriate SOP's as related to training, - Leads and coordinates educational training and assessments for orientation of new staff in Utilization Management (UM...
icims.com -
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...
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 Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Utilization...
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
Your Role
The Utilization Management Prior Authorization team processes accurate and timely prior authorization of designated healthcare services, continuity or care, and access to care clinical review determinations. The Utilization Management...
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
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
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
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
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...
Blue Shield of California-Rancho Cordova
experience
• 1-year work experience within the Medical Care Solutions’ Utilization Management Department or a similar medical management department at a different payor, facility, or provider/group.
• In-depth working knowledge of the prior authorization...
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