• Utilization Management Nurse Consultant…

    CVS Health (Sacramento, CA)
    …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
    CVS Health (08/15/25)
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  • Utilization Review Nurse Supervisor…

    The County of Los Angeles (Los Angeles, CA)
    …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.** -OR- OPTION II:… more
    The County of Los Angeles (08/18/25)
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  • System Utilization Management SUM…

    Alameda Health System (Oakland, CA)
    …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating ... System Utilization Management SUM Utilization Review...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical more
    Alameda Health System (08/22/25)
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  • Utilization Review Nurse Supervisor…

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR II Print...over the nursing staff engaged in utilization review activities at Los Angeles General Medical ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply  UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 - $177,314.88 Annually… more
    The County of Los Angeles (06/28/25)
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  • Utilization Review Tech II

    Prime Healthcare (Ontario, CA)
    …is actively seeking new members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization ... review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry,… more
    Prime Healthcare (08/23/25)
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  • Utilization Review Technician III

    Prime Healthcare (Ontario, CA)
    …is actively seeking new members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization ... health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working… more
    Prime Healthcare (08/23/25)
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  • Utilization Review , Management…

    Sutter Health (Sacramento, CA)
    …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices,… more
    Sutter Health (08/28/25)
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  • LVN - Quality Assurance/ Utilization

    Emanate Health (Covina, CA)
    …the United States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical more
    Emanate Health (07/23/25)
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  • Utilization Review Clinician - ABA

    Centene Corporation (Sacramento, CA)
    …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
    Centene Corporation (08/09/25)
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  • Licensed Vocational Nurse, Licensed Psychiatric…

    Sutter Health (Sacramento, CA)
    …Health! **Organization:** SCP-Sutter Center for Psychiatry **Position Overview:** The Utilization Review /Discharge Planner (UR/DP) performs chart review ... with a minimum of direction. + Critical thinking skills necessary to provide utilization review /discharge planning services appropriate to patients with complex … more
    Sutter Health (08/27/25)
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