- 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 ... protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices....using clinical judgment and refer to Medical Directors for review depending on case findings. **Job Requirements**… more
- 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 ... to work with a unique and supportive team. Our RN Case Managers work with multidisciplinary teams....include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review … more
- 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
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... SLH Case Manager RN + San Leandro,...Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.… more
- Cedars-Sinai (Marina Del Rey, CA)
- …named us one of America's Best Hospitals! **What You Will Do in This Role:** A Registered Nurse Case Manager plans and coordinates care of the patient from ... timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic ...like family. **Req ID** : 11148 **Working Title** : RN Case Manager - Case … more
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... + Posted:July 22, 2025 **Summary** **Job Summary:** The SLH Case Manager RN is responsible for providing...Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.… more
- Sharp HealthCare (San Diego, CA)
- …Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...the department head as indicated. + Utilization review and utilization managementThe RN … more
- CVS Health (Sacramento, CA)
- …demonstrated ability to make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted license in their state ... within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible… more
- UCLA Health (Los Angeles, CA)
- …of safe, high quality, efficient, and cost-effective care. You will also perform utilization review while assuring the delivery of concurrent and post-hospital ... accepted for current UCLA Health Nursing staff) + CA RN License and BLS certification + Recent experience in... License and BLS certification + Recent experience in case management, utilization management and discharge planning… more
- CenterWell (San Diego, CA)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more