• System Utilization Management SUM…

    Alameda Health System (Oakland, CA)
    System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Services As ... The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
    Alameda Health System (08/22/25)
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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 ... procedures/services or initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to… more
    CVS Health (08/15/25)
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  • Per Diem Registered Nurse II/III…

    Ventura County (Ventura, CA)
    Per Diem Registered Nurse II/III - Utilization Management ... II + Six (6) months of experience in Utilization Management Per Diem RN III ... VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply  Per Diem Registered Nurse II/III - Utilization Management VCMC… more
    Ventura County (08/10/25)
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  • Care Review Clinician, Inpatient…

    Molina Healthcare (San Diego, CA)
    …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 DAY SHIFT 7:30AM - 08:30PM PACIFIC HOURS NON EXEMPT, 3 days a week will… more
    Molina Healthcare (08/24/25)
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  • Care Review Clinician, Inpatient…

    Molina Healthcare (Sacramento, CA)
    …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **WORK SCHEDULE: Mon - Fri / Sun… more
    Molina Healthcare (08/24/25)
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  • Registered Nurse , Inpatient

    VNA Health (Santa Barbara, CA)
    …in clinical education, inservice and nursing staff meetings. + Participate in Quality Management and Utilization Review Activities. + Maintain necessary ... days per week, rotating weekends Job Description: The Inpatient Registered Nurse provides hospice care and is...and families in the General Inpatient setting. The Inpatient RN fully supports the Core Values and is accountable… more
    VNA Health (08/14/25)
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  • Utilization Management Nurse

    CVS Health (Sacramento, CA)
    …work._ **Required Qualifications** + 1 year of varied UM ( utilization management ) experience within an **outpatient** setting, concurrent review or prior ... make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted...+ 1 year of varied UM ( utilization management ) experience within an inpatient, concurrent review more
    CVS Health (08/15/25)
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  • Registered Nurse -Home Health…

    Veterans Affairs, Veterans Health Administration (Loma Linda, CA)
    …and initiatives as well as customer service programs. The Home Health Referral (HH) Registered Nurse ( RN ) is responsible for executing a streamlined approach ... The Home Health Referral RN is a registered professional nurse , qualified by education and...intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards,… more
    Veterans Affairs, Veterans Health Administration (08/21/25)
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  • Dialysis Clinical Manager Registered

    Fresenius Medical Center (San Bernardino, CA)
    …auditing activities. *Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. *Manages clinic financials ... including efficient utilization of supplies or equipment and regular profits and loss review . * Responsible for all required network reporting and on-site state… more
    Fresenius Medical Center (08/09/25)
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  • Registered Nurse - Clinical…

    Cedars-Sinai (Los Angeles, CA)
    …required Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of ... care field preferred Foreign trained MDs will be considered License/Certifications: Registered Nurse , LVN, Occupational Therapist, Physical Therapist, Physician… more
    Cedars-Sinai (06/19/25)
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