• Utilization Review Nurse LVN

    Prime Healthcare (Ontario, CA)
    …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236094/ utilization - review - nurse ... Required qualifications: + Possess an active CA Licensed Vocational Nurse (LVN) license. + Minimum (2) two years of...(2) two years of experience in acute hospital case management or equivalent. + Utilization Management… more
    Prime Healthcare (12/31/25)
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  • UM Prior Authorization Review Nurse…

    UCLA Health (Los Angeles, CA)
    Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based ... to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards,...+ A minimum of three years of experience in utilization management , preferred + Team leading or… more
    UCLA Health (01/01/26)
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  • Utilization Review Specialist

    TEKsystems (Los Angeles, CA)
    …Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes. ... Job Title: Retro Claims Reviewer Location: West Hills/Canoga Park 91305 Compensation: LVN...RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with… more
    TEKsystems (12/31/25)
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  • Utilization Management…

    Elevance Health (Costa Mesa, CA)
    …precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the ... ** Utilization Management Representative I** **Location** :...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
    Elevance Health (12/19/25)
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  • Director, Utilization Management

    Alameda Health System (Oakland, CA)
    Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
    Alameda Health System (11/07/25)
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  • RN Utilization Review - Full-time…

    Providence (Irvine, CA)
    **Description** **RN Utilization Review at Irvine, CA. This position is Full- time and will work Remote 8-hour, Day shifts.** Provide prospective, retrospective, ... strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The… more
    Providence (01/01/26)
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  • RN Utilization Review Full- time…

    Providence (Mission Hills, CA)
    …strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The ... reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers,... Utilization Management RN must effectively and efficiently manage a diverse… more
    Providence (12/16/25)
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  • Director of Case Management…

    Prime Healthcare (Inglewood, CA)
    …provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients… more
    Prime Healthcare (12/24/25)
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  • RN - Quality Assurance/ Utilization…

    Emanate Health (Covina, CA)
    …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... Requirement :** **Minimum Experience Requirement :** Minimum of three years of utilization management experience. Experience in quality- related job preferred.… more
    Emanate Health (12/06/25)
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  • RN Case Manager - Utilization Review

    Prime Healthcare (Lynwood, CA)
    …With Us! (https://careers-primehealthcare.icims.com/jobs/237903/rn-case-manager utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... and service! Responsibilities Responsible for the quality and resource management of all patients that are admitted to the...to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
    Prime Healthcare (12/19/25)
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