• Utilization Review Clinician - ABA

    Centene Corporation (Sacramento, CA)
    …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare… more
    Centene Corporation (08/09/25)
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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 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
    Alameda Health System (08/08/25)
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  • Utilization Management Coordinator

    Actalent (Santa Barbara, CA)
    …Medical management , Case management , Utilization management , Claim Top Skills Details Data entry,Concurrent review ,Prior authorization,Health ... and health services team members in the implementation and management of Utilization Management , Case...nursing standards of practice Skills Data entry, Concurrent review , Prior authorization, Health care, Medicare, Managed care,… more
    Actalent (08/01/25)
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  • Utilization Management Nurse

    CenterWell (Sacramento, CA)
    RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
    CenterWell (08/08/25)
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  • Utilization Management Nurse

    CenterWell (Sacramento, CA)
    …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous… more
    CenterWell (08/02/25)
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  • Clinical Documentation Integrity Lead - Service…

    Stanford Health Care (Palo Alto, CA)
    …experience. + ICU/ED and Academic Medical Center experience preferred. + Case management , utilization review and/or direct provider interaction experience, ... Health Care **What you will do** + Responsibility for management and optimization of the positive relationships between CDI...Document Spec . + CCDS-O or CDIP . + Nursing\ RN - Registered Nurse -… more
    Stanford Health Care (07/26/25)
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  • LVN Phys Pract

    Banner Health (Susanville, CA)
    …quality management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission ... position provides nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the quality of nursing… more
    Banner Health (06/29/25)
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  • Case Manager ( RN ) - Transitional Care…

    Stanford Health Care (Palo Alto, CA)
    …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure and/or Compact ... as scheduled. Whether this would be your first case management role or you are seasoned, here is your...include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review more
    Stanford Health Care (08/08/25)
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  • Assistant Nursing Director, Administration

    The County of Los Angeles (Los Angeles, CA)
    …the following: + Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT ... CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board...of staff, and evaluating employee performance. For this examination, Utilization Review is defined as provides technical… more
    The County of Los Angeles (07/19/25)
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  • Clinical Case Manager ( RN -LCSW-LMFT…

    Sharp HealthCare (San Diego, CA)
    …BBS Licensed Marriage and Family Therapist (LMFT) - CA Board of Behavioral Sciences; California Registered Nurse ( RN ) - CA Board of Registered Nursing ... (AHA BLS Healthcare) - American Heart Association + California Registered Nurse ( RN ) - CA...in use.Is knowledgeable of current laws and regulations regarding Utilization Review and Discharge Planning.Morning arrival time… more
    Sharp HealthCare (08/08/25)
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