• 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 + ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
    Alameda Health System (08/08/25)
    - Related Jobs
  • Utilization Management Admissions…

    LA Care Health Plan (Los Angeles, CA)
    Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
    LA Care Health Plan (10/03/25)
    - Related Jobs
  • RN Case Manager - Utilization Review

    Prime Healthcare (Lynwood, CA)
    …With Us! (https://careers-primehealthcare.icims.com/jobs/228577/rn-case-manager utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... and service! Responsibilities Responsible for the quality and resource management of all patients that are admitted to the...to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
    Prime Healthcare (10/16/25)
    - Related Jobs
  • Associate Manager, Clinical Health Services…

    CVS Health (Sacramento, CA)
    …+ 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization ... members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the… more
    CVS Health (10/15/25)
    - Related Jobs
  • Director of Case Management

    Prime Healthcare (Inglewood, CA)
    …provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients… more
    Prime Healthcare (10/18/25)
    - Related Jobs
  • Utilization Management

    Elevance Health (Los Angeles, CA)
    ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for...provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles… more
    Elevance Health (10/18/25)
    - Related Jobs
  • Utilization Management

    Elevance Health (Los Angeles, CA)
    ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... to 5:05 PM Pacific. Training hours may vary. The ** Utilization Management Representative I** is responsible for...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible… more
    Elevance Health (10/11/25)
    - Related Jobs
  • Case Manager (RN) - Utilization

    Prime Healthcare (San Dimas, CA)
    …Us! (https://careers-primehealthcare.icims.com/jobs/229285/case-manager-%28rn%29 utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... preferred, and community focused. Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from the… more
    Prime Healthcare (10/10/25)
    - Related Jobs
  • Nurse , Care Management

    Alameda Health System (Oakland, CA)
    Nurse , Care Management + Oakland, CA + Highland...in Case Management in an acute setting or utilization review at a medical group or health ... Management provides Care Coordination, Compliance, Transition Coordination, and Utilization Management . **DUTIES & ESSENTIAL JOB FUNCTIONS** NOTE:The… more
    Alameda Health System (10/18/25)
    - Related Jobs
  • Senior Mental Health Nurse

    Ventura County (Ventura, CA)
    …candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of experience ... evaluation, and review ; + Performs daily clinical reviews to support utilization and quality management , ensuring compliance with guidelines and standards… more
    Ventura County (09/26/25)
    - Related Jobs