• Clinical Reviewer, Nurse -9am -6pm PST

    Evolent (Sacramento, CA)
    …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
    Evolent (10/21/25)
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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 ... Differentials + Schedule: 3 days/week, 12 hours/day Job Description: The Inpatient Registered Nurse provides hospice care and is skilled at assessing pain and other… more
    VNA Health (09/07/25)
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  • Clinical Nurse Educator (Santa Rosa)

    Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
    …system and treatment methods, with specific knowledge and skills in areas of risk management , infection control, and utilization review . + Current knowledge ... and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Clinical Nurse Educator PAY RANGE: $135,200-$170,690 Annually REPORTS TO: Chief Nursing… more
    Sacramento Behavioral Healthcare Hospital (10/10/25)
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  • Registered Nurse - Health Education

    ERP International (San Diego, CA)
    **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Health Educator** supporting **Naval Medical Center San Diego, CA ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
    ERP International (10/18/25)
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  • Appeals Nurse

    Evolent (Sacramento, CA)
    …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management more
    Evolent (10/11/25)
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  • Telephonic Nurse Case Manager II

    Elevance Health (Los Angeles, CA)
    …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Sign on Bonus: $2000.**...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
    Elevance Health (08/29/25)
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  • Transplant Care Nurse - Remote

    Highmark Health (Sacramento, CA)
    …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
    Highmark Health (10/10/25)
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  • Registered Nurse - Clinical Documentation…

    Cedars-Sinai (Los Angeles, CA)
    …required Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of ... **Job Description** Are you ready to bring your advanced Health Information Management skills to a world-class facility recognized as one of the top ten in the… more
    Cedars-Sinai (09/18/25)
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  • Registered Nurse Case Manager - 5K Sign…

    VNA Health (Santa Barbara, CA)
    …a $5,000 sign on BONUS! Job Description: VNA Health is looking for compassionate Registered Nurse Case Managers (RN CM) to join our Home Health care team. The RN CM ... organizes and directs home care services. Responsibilities: + Responsible for continuous review of all aspects of every patient on his/her caseload to include:… more
    VNA Health (10/17/25)
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  • Dialysis Clinical Manager Registered Nurse

    Fresenius Medical Center (Newport Beach, 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 (09/19/25)
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