• System Utilization Management SUM…

    Alameda Health System (Oakland, CA)
    System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... 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 (07/29/25)
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  • Case Manager, Registered Nurse

    Sutter Health (Roseville, CA)
    …SMCS-Valley Administration **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the ... and at the appropriate level of care. Coordinates the utilization management , resource management , discharge...+ Bachelor's in Nursing preferred. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon… more
    Sutter Health (07/29/25)
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  • RN Supervisor UM Prior Auth

    Dignity Health (Rancho Cordova, CA)
    …working knowledge of Utilization Management Working knowledge of the Utilization Management review processes, and regulatory requirements. Must have ... and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for...or experience equivalent required. - Clear and current CA Registered Nurse ( RN ) license. -… more
    Dignity Health (06/20/25)
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  • Registered Nurse - Payment Integrity…

    LA Care Health Plan (Los Angeles, CA)
    Registered Nurse - Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position ... medical record review for Payment Integrity and Utilization Management projects. The position serves as...Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
    LA Care Health Plan (07/06/25)
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  • Care Review Clinician, Inpatient…

    Molina Healthcare (Los Angeles, 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 (08/08/25)
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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 ... - Friday; 8 Hour Shifts 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 (06/08/25)
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  • Managed Care Case Manager Nurse II

    Sutter Health (Goleta, CA)
    …- Santa Barbara **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's accepted ... and at the appropriate level of care. Coordinates the utilization management , resource management , discharge...an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California +… more
    Sutter Health (07/25/25)
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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 (07/30/25)
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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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  • Dialysis Clinical Manager Registered

    Fresenius Medical Center (Moreno Valley, 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...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
    Fresenius Medical Center (07/23/25)
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