• 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)
    - Related Jobs
  • 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)
    - Related Jobs
  • 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)
    - Related Jobs
  • 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)
    - Related Jobs
  • 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)
    - Related Jobs
  • 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 ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
    CenterWell (08/08/25)
    - Related Jobs
  • Care Manager RN - Utilization Review

    Providence (Napa, CA)
    **Description** Care Manager RN - Utilization Review unit at Providence Queen of the Valley Medical Center in Napa, CA. This position is Full-Time and will ... Schedule:** Full time **Job Shift:** Day **Career Track:** Nursing **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work… more
    Providence (08/08/25)
    - Related Jobs
  • 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)
    - Related Jobs
  • 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)
    - Related Jobs
  • 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)
    - Related Jobs