• Advanced Practice Provider (APP) Specialist,…

    J&J Family of Companies (San Francisco, CA)
    …Learn more at https://www.jnj.com/innovative-medicine Advanced Practice Providers (Nurse Practitioners / Physician Assistants) are a growing and critical segment of ... and product education, and to support HCPs in appropriate utilization of JJIM access and fulfilment resources. The APP-Specialist.... Advanced degree as either Nurse Practitioner (NP) or Physician Assistant (PA) . 3+ years as a NP… more
    J&J Family of Companies (08/12/25)
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  • Associate Medical Director - Orthopedic Spine

    Elevance Health (Walnut Creek, CA)
    …preferred. + Extensive spine surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. + **Orthopedic ... Determines the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + Conducts… more
    Elevance Health (08/02/25)
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  • Case Manager II, Registered Nurse

    Sutter Health (Burlingame, CA)
    …the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager, Medical Social Worker and bedside RN to assure ... of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through… more
    Sutter Health (08/10/25)
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  • Nurse Reviewer I (US)

    Elevance Health (Walnut Creek, CA)
    …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences ​ :** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
    Elevance Health (08/08/25)
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  • Care Manager II, Acute (RN)

    Sutter Health (Modesto, CA)
    …the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager, Medical Social Worker and bedside RN to assure ... of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through… more
    Sutter Health (06/28/25)
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  • Public Health Microbiologist I

    The County of Los Angeles (Los Angeles, CA)
    …Health Microbiologists are standardized with the procedures prescribed by laboratory management . These procedures are available to Public Health Microbiologists I in ... such finding are consistent with overall clinical symptoms indicated by the attending physician . When findings do not appear to be consistent with the clinical… more
    The County of Los Angeles (06/26/25)
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  • Field Based Psychiatric Technician - Behavioral…

    Ventura County (Ventura, CA)
    …+ Utilization review: + Uses professional skills in quality management activities such as utilization review, monitoring and evaluation procedures, ... need at every stage of their journey. THE POSITION: Under direction of a physician or registered nurse, the Field Based Psychiatric Technician performs a variety of… more
    Ventura County (08/07/25)
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  • Pharmacist I - Sharp Grossmont Hospital - Variable…

    Sharp HealthCare (La Mesa, CA)
    …(EMR System, Automated Dispensing Cabinet system (Pyxis), IV Workflow Management system (DoseEdge), physician order entry, etc.)-Demonstrates knowledge ... up on formulary compliance issues and/or communicates issues to management .-Documents interventions, patient contact, and multidisciplinary communication consistent with… more
    Sharp HealthCare (08/03/25)
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  • RN Clinical Manager Home Health Full Time

    CenterWell (San Diego, CA)
    …care plans and interpreting patient needs, while adhering to Company, physician , and/or health facility procedures/policies. + Manages the assignment of caregivers. ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
    CenterWell (06/07/25)
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  • Clinical Documentation Integrity Lead - Service…

    Stanford Health Care (Palo Alto, CA)
    …cycle certification- Health Care Quality (HACP, CPHQ, HCQM) certification- Case Management Certification (CCM) or clinical certification- Physician Educator ... + ICU/ED and Academic Medical Center experience preferred. + Case management , utilization review and/or direct provider interaction experience, preferred.… more
    Stanford Health Care (07/26/25)
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