Top 122 Clinical documentation & utilization review Jobs in Folsom, Ca

Operations Specialist, Associate
Blue Shield of California —El Dorado Hills, CA
- $28.33 - $39.66 an hour
- Full-time
- Hybrid work
- Background check
- Writing skills
- Pass drug screening
- Work from home
23h
Occupational Therapist - $5,000 SIGN ON BONUS!!!
Roseville Point Health& Wellness Center —Roseville, CA
- $65 - $72 an hour
- Full-time
- Background check
- CPR Certification
- Management
- Health insurance
Quick Apply
Mental Health Clinician - Hiring Bonus Available
EL HOGAR COMMUNITY SERVICES INC —Sacramento, CA
- $35 - $38 an hour
- Full-time
- LMFT
- Addiction Medicine
- Licensed Clinical Social Worker
Quick Apply
Associate Medical Director, Pediatrics
Elica Health Centers —Sacramento, CA
- Medicine
- Current TB test
- PALS Certification
- Paid holidays
- Health insurance
Quick Apply
Speech Language Pathologist - $5,000 SIGN ON BONUS!!!
Roseville Point Health & Wellness Center —Roseville, CA
- $65 - $75 an hour
- Part-time
- CPR Certification
- Management
- Writing skills
- Health insurance
Quick Apply
Speech Language Pathologist Senior Living
Reliant Rehabilitation —Carmichael, CA
- $65 - $70 an hour
- Weekends as needed
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Physical Therapist Senior Living
Reliant Rehabilitation —Carmichael, CA
- $55 - $70 an hour
- Part-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Residential Clinical Director
DIAMOND HOUSE DETOX —Sacramento, CA
- $120,000 a year
- Background check
- LMFT
- Current TB test
- Paid holidays
- Health insurance
Quick Apply
Pedodontist
Elica Health Centers —Sacramento, CA
- $190,000 - $250,000 a year
- Full-time
- Dental office
- Current TB test
- BLS Certification
- Paid holidays
- Health insurance
Quick Apply
Director of Rehabilitation, $5,000 Sign on Bonus!!!
Roseville Point Healthcare & Wellness Center —Roseville, CA
- $140,000 - $160,000 a year
- Full-time
- Customer service
- Physical & Rehabilitation Medicine
- Quality control
- Paid holidays
- Health insurance
Quick Apply
7d
Occupational Therapist Senior Living
Reliant Rehabilitation —Carmichael, CA
- $55 - $70 an hour
- Part-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Physical Therapist Assistant Senior Living
Reliant Rehabilitation —Carmichael, CA
- $44 - $55 an hour
- Part-time
- Physical & Rehabilitation Medicine
- English
- Mid-level
Occupational Therapy Assistant Senior Living
Reliant Rehabilitation —Carmichael, CA
- $44 - $55 an hour
- Part-time
- Management
- English
- Mid-level
Director of Rehabilitation Senior Living
Reliant Rehabilitation —Carmichael, CA
- $58 - $64 an hour
- Weekends as needed
- Microsoft Excel
- Microsoft Outlook
- Customer service
System Accreditation and Regulatory Specialist
Adventist Health —Roseville, CA
- $81,273 - $121,909 a year
- Full-time
- Hospital
- Mid-level
- Clinic
Utilization Management Nurse, Senior
Blue Shield of California —El Dorado Hills, CA
- $90,860 - $136,290 a year
- Weekends as needed
- Hybrid work
- Background check
- Nursing
- RN License
- Work from home
System Accreditation and Regulatory Specialist (Roseville)
Adventist Health —Roseville, CA
- $81,273 - $121,909 a year
- Hospital
- Mid-level
- Clinic
Project Policy Analyst 4
UC Davis Health —Sacramento, CA
- $3,440 - $6,328 a month
- Full-time
- Background check
- Pass drug screening
- Mid-level
- Continuing education credits
- Paid holidays
Digital Personalization Product Manager
Blue Shield of California —El Dorado Hills, CA
- $123,100 - $184,800 a year
- Full-time
- Hybrid work
- Background check
- 6 years
- Computer Science
- Work from home
Assistant Health Services Administrator - ((RN License Required))
CHP Health —Roseville, CA
- $130,000 - $170,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Continuing education credits
- Paid holidays

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Operations Specialist, Associate

Blue Shield of California -
El Dorado Hills, CA

Apply Now

Job Details

Full-time
$28.33 - $39.66 an hour
23 hours ago

Benefits

Work from home

Qualifications

Risk assessment

Full Job Description

Your Role

The Behavioral Health Utilization Management team provides Utilization Management and Care Coordination for Promise Blue Shield members seeking BHT services. The Operations Specialist, Associate will report to the Sr. Manager of Behavioral Health Utilization Management. In this role you will assist with audit preparedness, act as a Behavioral Health subject matter expert (SME) for Utilization Management and Care Coordination/Management systems development and testing, and contribute to the development of tools, processes, and frameworks that advance best practices and deliver successful utilization management of behavioral health services.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

Act as subject matter expert and review operational workflows, identifying problems and acting as a SME to inform improvements, modifications, and enhancements
Track and communicate workflow and system changes to appropriate resources
Review systems and applications and recommend system edits/changes as needed
Notify appropriate department managers about issues and problems in operational workflow requiring immediate attention
Participate as a subject matter expert to inform the development of written guidelines and documents problems as needed
Assist with audit readiness including file preparation and risk assessment
Conduct system testing for Utilization Management and Care Management
Support department oversight and daily operations through report and system review; providing validation and escalating issues to leadership as needed

Your Knowledge and Experience

Requires a bachelor’s degree; or high school (GED) and 4 years relevant experience
0 years of prior relevant experience required if bachelor’s degree
4 years of prior relevant experience if high school or GED
Requires health plan (managed care, government payer, academic) or healthcare experience (working for a provider)
Foundational understanding of managed care utilization management, preferred
Experience with writing workflows and processing documentation, preferred
Ability to work independently
Strong critical thinking skills with attention to detail

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

ABOUT THE TEAM
About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

For most teams, this means coming into the office two days per week.
Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Apply Now

Refine Your Search

clinical documentation & utilization review jobs in folsom, ca

Operations Specialist, Associate

Occupational Therapist - $5,000 SIGN ON BONUS!!!

Mental Health Clinician - Hiring Bonus Available

Associate Medical Director, Pediatrics

Speech Language Pathologist - $5,000 SIGN ON BONUS!!!

Speech Language Pathologist Senior Living

Physical Therapist Senior Living

Residential Clinical Director

Pedodontist

Director of Rehabilitation, $5,000 Sign on Bonus!!!

Occupational Therapist Senior Living

Physical Therapist Assistant Senior Living

Occupational Therapy Assistant Senior Living

Director of Rehabilitation Senior Living

System Accreditation and Regulatory Specialist

Utilization Management Nurse, Senior

System Accreditation and Regulatory Specialist (Roseville)

Project Policy Analyst 4

Digital Personalization Product Manager

Assistant Health Services Administrator - ((RN License Required))

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