• Utilization Review Nurse Supervisor I

    The County of Los Angeles (Los Angeles, CA)
    …staff training is needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to ... year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.**...provided to patients are appropriate and covered by the insurance payer. They are responsible for ensuring that patient… more
    The County of Los Angeles (05/22/25)
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  • Registered Nurse - Peer Review

    Veterans Affairs, Veterans Health Administration (San Francisco, CA)
    …the Medical Center's improvement methodology and framework, and external review standards. Identifies when the review identifies system and process ... Summary The Quality and Patient Safety office (QPS) Peer Review Nurse completes and/or coordinates all aspects of the Peer Review Program. The incumbent works… more
    Veterans Affairs, Veterans Health Administration (08/08/25)
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  • System Utilization Management SUM Utilization…

    Alameda Health System (Oakland, CA)
    …outpatient). 3. Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity criteria. ... of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in appropriate… more
    Alameda Health System (07/29/25)
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  • Payment Review Analyst

    CalSTRS (Sacramento, CA)
    …+ Alternative work schedules + Flexible work hours + Remote work options + Medical benefits, including health, dental and vision insurance + Paid holidays and ... Job Posting: Payment Review Analyst State Teachers' Retirement System JC-487215 -...three weeks of vacation/sick leave for staff + Health insurance in retirement + Employee Assistance Program + Loan… more
    CalSTRS (08/08/25)
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  • Care Manager RN - Utilization Review *Full…

    Providence (Napa, CA)
    …Manager RN - Utilization Review unit at Providence Queen of the Valley Medical Center in Napa, CA. This position is Full-Time and will work 8-hour Day shifts. ... including a retirement 401(k) Savings Plan with employer matching, health care benefits ( medical , dental, vision), life insurance , disability insurance , time… more
    Providence (08/08/25)
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  • Utilization Review Clinician - ABA

    Centene Corporation (Sacramento, CA)
    …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care… more
    Centene Corporation (08/09/25)
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  • Senior Project Manager (Cost Reimbursement…

    Harris & Associates (Irvine, CA)
    …and expertise of the incoming candidate. In addition to base salary, we also offer: * Medical , dental, vision, and life insurance * ESOP * 401K Match * PTO, 8 ... to help lead, market and expand our Cost Reimbursement Review team. The ideal candidate will have strong project...Paid Leave Programs such as maternity, parentally, and family medical leave Harris & Associates is an Equal Opportunity… more
    Harris & Associates (05/13/25)
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  • Senior Estimate Review Specialist

    Sedgwick (San Francisco, CA)
    …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Senior Estimate Review Specialist **PRIMARY PURPOSE** **:** To review ... or university preferred. **Experience** Five (5) years of experience in insurance adjusting or construction background or equivalent combination of education and… more
    Sedgwick (06/29/25)
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  • Loan Review Specialist

    TEKsystems (Thousand Oaks, CA)
    Description The Conditions Specialist is responsible for the pre-purchase review of Conventional, Non-Conforming, FHA, and VA loan files to ensure file contains the ... documentation. * Be an integral part of the pre-purchase review of Conventional, Non-Conforming, FHA, and VA loans files...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more
    TEKsystems (08/08/25)
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  • Physician Advisor, Utilization Review

    Sutter Health (Sacramento, CA)
    …regarding physician practice patterns, over- and under-utilization of resources, medical necessity, documentation best practices, level of care progression, denial ... compliance with governmental regulations and conditions of participation and commercial insurance contracts. The PA is responsible for establishing, maintaining and… more
    Sutter Health (06/12/25)
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