Sacramento, California, United States · On-site
$110k–$123k/yr
We’re delighted you’re considering joining us! At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticip…
Skills: Utilization Management, Clinical Nursing, Medical Necessity Review, ICD-10 Coding, CPT Coding
Sacramento, California, United States · On-site
$100k–$123k/yr
We’re delighted you’re considering joining us! At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticip…
Skills: Utilization Management, Medical Necessity Review, Epic Tapestry, MCG, ICD-10
Sacramento, California, United States · On-site
$131k–$178k/yr
Are you passionate about helping mission-driven organizations harness the power of cloud technology and AI to amplify their impact? Amazon Web Services (AWS) is seeking a Customer Solutions Manager (CSM) to join our EDU …
Skills: Cloud Adoption, AI Transformation, Program Management, Customer Relationship Management, Strategic Planning
Sacramento, California, United States · On-site
$72k–$90k/yr
The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need as…
Skills: Underwriting Principles, Risk Evaluation, Policy Structure, Binding Authority, Market Placement Strategies
Sacramento, California, United States · On-site
$25/hr–$32/hr
Clad Consulting, Inc. is seeking multiple Field Engineers (Inspectors) to join our growing team for a large-scale infrastructure project to support underground construction across roadways, highways, and municipalities t…
Skills: Construction Inspection, Field Engineering, Surveying, GIS Data Collection, Plan Reading
Sacramento, California, United States · Hybrid
$215k–$390k/yr
Greenberg Traurig (GT), a global law firm, has an exciting full-time employment opportunity for a 2nd – 6th year Associate in the U.S. State and Local Tax (SALT) Practice of our Sacramento or San Francisco office. We off…
Skills: State and Local Tax, Tax Planning, Tax Controversy, Audit Defense, Legal Writing
Sacramento, California, United States · Hybrid
$90k–$125k/yr
SUMMARY: Under limited supervision, the Industry Segment Spec III develops proposals and assesses customer needs in order to recommend appropriate products and services for his/her assigned segment of responsibility. May…
Skills: Analytical Skills, Written Communication, Verbal Communication, Technical Sales, Product Configuration
Fresno, California, United States · Hybrid
$137k–$198k/yr
Our vision for the future is based on the idea that transforming financial lives starts by giving our people the freedom to transform their own. We have a flexible work environment, and fluid career paths. We not only en…
Skills: Wealth Management, Financial Planning, Relationship Management, Investment Strategy, Tax Optimization
Sacramento, California, United States · On-site
Stop building someone else's dream. Love your community? Get paid to highlight it. Combine local passion with a multi-channel advertising powerhouse. Your Role: Consult: Conduct in-person meetings with local business own…
Skills: Negotiating, Closing, Digital Advertising, Print Advertising, Branding
Sacramento, California, United States · On-site
$65k–$100k/yr
Description We are LP Insurance LP Insurance Services is an established and growing insurance brokerage firm, located in Arizona, California, Nevada, New Mexico and Oregon. We invest in our employees, clients and communi…
Skills: Commercial Insurance Coverage, Account Management, Client Relationship Management, Underwriting Negotiation, Proposal Preparation
Sacramento, California, United States · Hybrid
$28/hr–$35/hr
Description Bring your passion, creativity, and talent for page layout, marketing communications, and writing to a role where your work directly supports meaningful environmental projects across California and the Wester…
Skills: Proposal Development, Copywriting, Editing, Formatting, Proofreading
Sacramento, California, United States · Remote OK
$70k–$85k/yr
Our Why We strive to have every interaction be exceptional so that each connection builds towards a meaningful relationship; all while creating an environment where our Employees, Clients and Community thrive. We don't r…
Skills: Payroll Sales, HCM Solutions, Consultative Selling, Pipeline Management, Relationship Building
Larkspur, California, United States · Hybrid
$120k–$150k/yr
ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the worlds' largest insurance brokers, our focus is dedicated to providing our customers with…
Skills: Staff Supervision, Commercial Insurance, Performance Management, Client Relationship Management, Project Management
Sacramento, California, United States · Hybrid
$150k–$170k/yr
ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the worlds' largest insurance brokers, our focus is dedicated to providing our customers with…
Skills: Quality Assurance, Compliance Monitoring, Audit Program Design, E&O Prevention, Commercial Insurance Operations
Emeryville, California, United States · Hybrid
$34/hr–$59/hr
We are so glad you are interested in joining Sutter Health! Organization: SHSO-Sutter Health System Office-Valley Position Overview: Responsible for implementation of strategic priority projects designed and deployed to …
Skills: Project Management, Strategic Implementation, Leadership, Coaching, Facilitation
Sacramento, California, United States · On-site
$38/hr–$59/hr
Description About Us: 4LEAF, Inc. (4LEAF) is a multi-discipline Firm providing services throughout the United States. For more than 25 years, 4LEAF has assisted clients in successfully navigating contract services leadin…
Skills: Building Inspection, Code Enforcement, Plan Checking, Technical Analysis, Customer Service
Sacramento, California, United States · On-site
$140k–$210k/yr
Company Description Work with Us. Change the World. At AECOM, we're delivering a better world. Whether improving your commute, keeping the lights on, providing access to clean water, or transforming skylines, our work he…
Skills: Data Modeling, Predictive Modeling, Power BI, Python, R
Sacramento, California, United States · On-site
$107k–$190k/yr
Company Description Work with Us. Change the World. At AECOM, we're delivering a better world. Whether improving your commute, keeping the lights on, providing access to clean water, or transforming skylines, our work he…
Skills: Project Management, Pre-construction Planning, Budget Management, Schedule Management, Contractor Management
Sacramento, California, United States · On-site
$94k–$150k/yr
Company Description At KPFF Consulting Engineers, we are more than just an engineering design firm. For over 65 years, we have dedicated ourselves to innovative, sustainable engineering that shapes the built environment …
Skills: Project Management, Civil Engineering Design, Client Relationship Management, Budget Management, Staff Mentorship
Sacramento, California, United States · On-site
$94k–$150k/yr
Company Description At KPFF Consulting Engineers, we are more than just an engineering design firm. For over 65 years, we have dedicated ourselves to innovative, sustainable engineering that shapes the built environment …
Skills: Project Management, Civil Engineering, Client Relationship Management, Budget Management, Staff Mentoring
Sacramento, California, United States • On-site
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Evaluate and process urgent and non-urgent medical authorization requests based on established medical necessity and benefit criteria. Collaborate with Medical Directors and providers to ensure timely and appropriate medical care for members.
Requires an active, unrestricted California RN or LVN license and a minimum of three years of clinical nursing experience. Proficiency in ICD-10/CPT coding and experience in utilization management are preferred.
At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.
At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.
We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!
The Authorization Nurse is responsible for the evaluation of medical appropriateness and necessity for a variety of services using contracts, medical policies, and evidence-based clinical guidelines while also ensuring benefit and eligibility requirements are met. They work with physician reviewers and providers to meet the health care needs of members so that they can receive efficient and timely medical care.
Review and process urgent and non-urgent authorization requests (received via phone, fax and electronic submission) for medical necessity (according to established criteria) and authorize, pend or modify as appropriate.
Process authorization requests (routine, urgent and retrospective) according to regulatory requirements.
Utilize a variety of medical necessity, contractual and benefit criteria to determine appropriate authorization decisions. Criteria may include MCG, Hill Guidelines, Health Plan Criteria, Health Plan and Hill Physician contracted provider data and member benefit information.
Obtain additional medical information as necessary from requesting provider.
Communicate with providers and members regarding status of authorization requests.
Assist interdepartmental staff members to resolve issues relating to the authorization process.
Refer information regarding members to other departments as appropriate for follow-up (i.e., Case Management, Health Education, TPL, COB).
Ensure quality authorization processing while meeting individual and team productivity standards.
Clearly and succinctly document necessary and/or required information in Epic Tapestry system.
Utilize critical thinking skills to identify process issues and problems and recommend and/or implement solutions.
Prepare and present cases to physician reviewers/UM Medical Director in a concise, objective and organized manner.
Collaborate with physician reviewers, Utilization Management Medical Director and other designated physician leaders on making clinical decisions.
Participate in on-call or alternate work hour programs as needed to meet regulatory compliance requirements.
Perform other duties as assigned by supervisor/manager.
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Active, unrestricted California Licensure: Registered (RN) or Licensed Vocational Nurse (LVN).
Bachelor’s degree in nursing strongly preferred
Minimum 3 or more years pertinent experience in Managed Care Utilization Management
Experience with medical decision supports tools such as MCG.
Previous experience with Epic Tapestry platform preferred but not required.
Knowledge of ICD-10 and CPT coding.
Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
Excellent verbal and written communication skills.
Ability to work effectively with a variety of customers including physicians, office staff, and members.
Demonstrated organization and time management skills with the ability to prioritize workload and meet expected and unexpected time frames.
Strong analytical and critical thinking skills.
Ability to take action in solving problems exhibiting sound judgement.
Demonstrated comfort with ambiguity and change.
Ability to work independently with self-initiative and discipline.
Adaptable/flexible -- enjoys doing work that requires frequent shifts in direction
Detail-oriented -- would rather focus on the details of work than the bigger picture
High stress tolerance -- thrives in a high-pressure environment
Demonstrated critical thinking and inquisitiveness in reviewing UM cases for appropriate global review and decision-making.
Salary: $100,000 - $123,000 Annual
Offices: 2409 CAMINO RAMON, San Ramon, California 94583, us
View all jobs at PriMed Management Consulting Services, Inc.Based on 282 listings with disclosed salaries, most consulting jobs in Sacramento, CA pay between $68k–$180k per year. Individual offers vary with seniority, company size, and specialization.
There are currently 336 open consulting positions in Sacramento, CA listed on Clera. New openings are added daily as companies post roles.
Companies currently hiring include AECOM, HDR, HUB International, Capio Group, KPFF Consulting Engineers, among others. Browse the listings above to see every active employer.
Yes — 176 of the 336 open consulting positions offer remote or hybrid work (63 remote, 113 hybrid).
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.
