Top 89 Utilization review Jobs in Sacramento Ca

Utilization Review LVN
Dignity Health Medical Foundation —Rancho Cordova, CA
- $35.62 - $52.99 an hour
- Full-time
- LVN
- Research
- Mid-level
- Work from home
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —Sacramento, CA
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
Care Review Clinician, RN/LPN
Molina Healthcare —Sacramento, CA
- $27.61 - $53.83 an hour
- Full-time
- Mid-level
- LPN
- Acute care experience
- Health insurance
Utilization Review Case Management Supervisor
CorVel Corporation —Folsom, CA
- $77,960 - $120,368 a year
- Full-time
- Nursing
- RN License
- Sales
- Health savings account
- Disability insurance
Quick Apply
RN, Care Manager, Utilization Management (Part-time, Every weekend - Remote)
Adventist Health —Roseville, CA
- $59.23 - $81.24 an hour
- Part-time
- Remote
- Nursing
- RN License
- Mid-level
13d
Physical Therapist
Roseville Point Health and Wellness Center —Roseville, CA
- $58 - $62 an hour
- Full-time
- Background check
- CPR Certification
- Management
- Health insurance
Quick Apply
Speech Language Pathologist
Roseville Point Health & Wellness Center —Roseville, CA
- $58 - $62 an hour
- Part-time
- CPR Certification
- Management
- Writing skills
- Health insurance
Quick Apply
Occupational Therapy Assistant Senior Living
Reliant Rehabilitation —Davis, CA
- $44 - $55 an hour
- Weekends as needed
- English
- Mid-level
- Ability to lift 50 pounds
Mental Health Clinician
Sierra Mental Wellness Group —Roseville, CA
- $35 - $40 an hour
- Part-time
- Hybrid work
- Background check
- LMFT
- Spanish
- Mileage reimbursement
- Loan repayment program
Quick Apply
MD or DO for Skilled Nursing
Community Health Centers of America —Sacramento, CA
- $240,000 - $350,000 a year
- Part-time
- Medicine
- Skilled nursing facility
- BC/BE
- Paid holidays
- Health insurance
Quick Apply
12d
RN Case Manager
AMN Healthcare —Sacramento, CA
- $1,800 - $2,700 a week
- 8 hour shift
- RN License
- Hospital
- BLS Certification
- Paid jury duty
- Paid holidays
11d
RN Case Manager
AMN Healthcare —Sacramento, CA
- $1,800 - $2,700 a week
- 8 hour shift
- RN License
- Hospital
- BLS Certification
- Paid jury duty
- Paid holidays
11d
RN Case Manager
AMN Healthcare —Carmichael, CA
- $1,800 - $2,700 a week
- 8 hour shift
- Nursing
- RN License
- Hospital
- Paid jury duty
- Paid holidays
Travel RN Case Manager/Care Coordinator $80/HR
MTK Healthcare —California
- $76 - $80 an hour
- 8 hour shift
- Background check
- RN License
- Hospital
Quick Apply
3d
Psychiatrist
Beloved Ones —California
- $200,000 - $250,000 a year
- Weekends as needed
- Remote
- Background check
- Medicine
- Doctoral degree
- Flexible schedule
Quick Apply
Senior Director Clinical Quality and Policy
Delta Dental —Rancho Cordova, CA
- $190,254 - $439,724 a year
- Full-time
- Hybrid work
- Background check
- Analysis skills
- Bachelor's degree
- Paid holidays
- Health insurance
Professional Review Nurse
CorVel Corporation —Folsom, CA
- $70,304 - $85,473 a year
- Full-time
- Remote
- Nursing
- RN License
- Data analysis skills
- Health savings account
- Disability insurance
Quick Apply
CA Telephonic Case Manager I
CorVel Corporation —Folsom, CA
- $30.64 - $45.80 an hour
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
11d
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Sacramento, CA
- $3,126 a week
- 8 hour shift
- Acute care
- RN License
- Hospital
Quick Apply
11d
Value Analysis Coordinator/Strategic Sourcing
UC Davis Health —Sacramento, CA
- $3,275.86 - $6,026.82 a month
- Full-time
- Hybrid work
- Background check
- Microsoft Excel
- Customer service
- Continuing education credits
- Paid holidays

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Utilization Review LVN

Dignity Health Medical Foundation -
Rancho Cordova, CA

Apply Now

Job Details

Full-time
$35.62 - $52.99 an hour

Benefits

Work from home

Qualifications

LVN
Phone communication
Contract interpretation
Utilization management
Resource utilization in healthcare
Insurance policy review
Quality data entry

Full Job Description

Job Summary and Responsibilities

As our Utilization Review LVN, your focus will be to provide high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary.

Every day you will assist in determining appropriateness, quality and medical necessity of referral requests using pre-established guidelines. This position supports the Medical Group in effective management of the managed care patient. This position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review.

To be successful in this role, you will effectively manage patient charts, demonstrating enthusiasm, efficiency, and empathy, while ensuring accurate application of criteria to support optimal patient care and operational flow.

As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories.

This position is work from home within California, with initial orientation onsite in the Sacramento region.

Manages assigned queues on a daily basis working oldest referrals first to assure 98% compliance with ICE timeframes.
Follows job work aide in sequence of performing job, including checking eligibility on health plan websites. Demonstrates 100% accuracy of identification of Medical Group member before referral review is initiated.
Determines correct type of referral and utilizes correct criteria in performing review and documents appropriate sections with 95% accuracy.
Researches correct information and/or uses pend letter appropriately when facts are needed to reach determination.
Preps case thoroughly, concisely and clearly for physician review. Researches EMR, criteria, medical policy and past history of member to detail case cleanly for MD. Watches for follow up and processes denials as indicated, demonstrating correct identification of reasons for denial.
Recommends and coordinates interventions to facilitate high quality, cost-effective care, monitoring treatment, progress and outcomes of patients.

Job Requirements

Required

Three (3) years Utilization Management (UM) experience
Five (5) years LVN experience
Clear and current CA Licensed Vocational Nurse (LVN) license
Strong knowledge nursing requirements in a clinical setting
Knowledge of utilization management programs as related to pre-set protocols and criteria
Knowledge of health plans, medical specialty procedures and diagnoses
Ability to work within an interdisciplinary structure and function independently in a fast paced environment while managing multiple priorities and meeting deadlines
Ability to apply clinical judgment to complex medical situations and make quick decisions
Ability to read and interpret benefit contract specifications
Ability to understand and follow established criteria and protocols used in managed care functions
Strong organization skills
Effective telephone and computer data entry skills
Ability to formulate ideas and solutions into appropriate questions and assess/interpret the verbal responses

Preferred

Experience at meeting deadlines by prioritizing work flow preferred
Physician group experience preferred
General knowledge of UM and Managed Care preferred
Use of InterQual guidelines preferred
Knowledge of California health plans and differences between commercial and advantage plans preferred
Familiarity with business practices and protocols with ability to access data and information using automated systems preferred
Ability to communicate effectively with coworkers, members, their families, physicians and health care providers preferred

Where You'll Work

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. Our 130+ clinics across the state of California deliver high-quality, patient-centric care with an emphasis on humankindness. Through affiliations with Dignity Health hospitals, along with our joint ventures and partnerships, we offer a robust, state-of-the-art health care delivery system in the communities we serve .We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.

One Community. One Mission. One California

Pay Range
$35.62 - $52.99 /hour

Apply Now

Refine Your Search

utilization review jobs in sacramento ca

Utilization Review LVN

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

Care Review Clinician, RN/LPN

Utilization Review Case Management Supervisor

RN, Care Manager, Utilization Management (Part-time, Every weekend - Remote)

Physical Therapist

Speech Language Pathologist

Occupational Therapy Assistant Senior Living

Mental Health Clinician

MD or DO for Skilled Nursing

RN Case Manager

RN Case Manager

RN Case Manager

Travel RN Case Manager/Care Coordinator $80/HR

Psychiatrist

Senior Director Clinical Quality and Policy

Professional Review Nurse

CA Telephonic Case Manager I

Travel RN - Case Management/Utilization Review - Case Management

Value Analysis Coordinator/Strategic Sourcing

I want to receive the latest job alert for utilization review in sacramento ca

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