• Sr Spec-Integrated Care Mgmt - Utilization

    Sharp HealthCare (San Diego, CA)
    …will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM. ... will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM.… more
    Sharp HealthCare (08/02/25)
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  • Discharge Planner II (LVN) - Utilization

    Prime Healthcare (San Dimas, CA)
    …EDUCATION, EXPERIENCE, TRAINING Required qualifications. 1. Knowledge in discharge planning/ utilization management /case management terminology and functions, ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/214912/discharge-planner-ii-%28lvn%29 utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySan… more
    Prime Healthcare (07/15/25)
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  • Utilization Management Nurse

    CenterWell (Sacramento, CA)
    …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
    CenterWell (08/08/25)
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  • Utilization Management Nurse

    CenterWell (Sacramento, CA)
    …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
    CenterWell (08/02/25)
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  • Utilization Review RN

    Dignity Health (Long Beach, CA)
    …effectively with multiple stakeholders + Professional communication skills. + Understand how utilization management and case management programs integrate. + ... hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year...+ Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Proficient in application of… more
    Dignity Health (08/10/25)
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  • Utilization Review RN

    Prime Healthcare (Ontario, CA)
    …school of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization Manager working for a Health Plan. + At least 3 years of ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/211752/ utilization -review-rn/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
    Prime Healthcare (08/08/25)
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  • Clinical Health Services Associate Manager

    CVS Health (Sacramento, CA)
    …level. The Associate Manager is also responsible for oversight of utilization management nurses including the organization and development of high performing ... some rotational on-call holiday coverage as needed. The Associate Manager is accountable to support the day to day...compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area +… more
    CVS Health (08/08/25)
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  • RN Supervisor UM Prior Auth

    Dignity Health (Rancho Cordova, CA)
    …home.** **Position Summary:** Under the guidance and supervision of the department Manager /Director the Supervisor of Utilization Management is responsible ... sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management guidelines… more
    Dignity Health (06/20/25)
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  • Authorization Technician II (12 Month Assignment)

    LA Care Health Plan (Los Angeles, CA)
    …staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an ... Authorization Technician II (12 Month Assignment) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type:… more
    LA Care Health Plan (08/08/25)
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  • Case Manager I - Sharp Memorial Hospital…

    Sharp HealthCare (San Diego, CA)
    …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... policy.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
    Sharp HealthCare (07/13/25)
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