• Utilization Review Nurse

    The County of Los Angeles (Los Angeles, CA)
    …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION II: ... UTILIZATION REVIEW NURSE SUPERVISOR...for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the… more
    The County of Los Angeles (05/22/25)
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  • Utilization Management Nurse

    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 (08/01/25)
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  • Utilization Review Nurse

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

    CVS Health (Sacramento, CA)
    …in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience… more
    CVS Health (07/30/25)
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  • Utilization Management Nurse

    CVS Health (Sacramento, CA)
    …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services. +… more
    CVS Health (07/22/25)
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  • Utilization Management Nurse

    CVS Health (Sacramento, CA)
    …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible,...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
    CVS Health (08/01/25)
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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 (07/29/25)
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  • Utilization Management Nurse

    CenterWell (Sacramento, CA)
    …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
    CenterWell (08/02/25)
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  • LVN - Quality Assurance/ Utilization

    Emanate Health (Covina, CA)
    …States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... 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 RN

    Prime Healthcare (Ontario, CA)
    …working for a Health Plan. + At least 3 years of experience in utilization review , referrals, authorizations, denials and appeals. + Current BCLS (AHA) ... cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the...accredited school of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization more
    Prime Healthcare (08/08/25)
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