• Utilization Management Manager,…

    UCLA Health (Los Angeles, CA)
    …+ experience in an HMO environment + Thorough knowledge of health care industry, utilization review , utilization management , and concurrent review ... at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management...following major functions: + Pre-service Authorizations/Denial Letters + Concurrent Review + Continuity of Care + Retro Claims +… more
    UCLA Health (12/30/25)
    - 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 (12/24/25)
    - Related Jobs
  • Discharge Planner - Utilization

    Prime Healthcare (Montclair, CA)
    …EDUCATION, EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/221097/discharge-planner utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityMontclair… more
    Prime Healthcare (12/30/25)
    - Related Jobs
  • Utilization Management

    Elevance Health (Costa Mesa, CA)
    ** Utilization Management Representative I** **Location** : 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 I** is responsible for...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible… more
    Elevance Health (12/19/25)
    - Related Jobs
  • Registered Nurse - Utilization

    Cedars-Sinai (Los Angeles, CA)
    …more about you and your skills! **What will you be doing in this role?** The Utilization Review Case Manager validates the patient's placement to be at the most ... Manager follows the UR process as defined in the Utilization Review Plan in accordance with the...- PER DIEM - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
    Cedars-Sinai (01/02/26)
    - Related Jobs
  • RN Utilization Review - Full-time…

    Providence (Irvine, CA)
    **Description** **RN Utilization Review at Irvine, CA. This position is Full- time and will work Remote 8-hour, Day shifts.** Provide prospective, retrospective, ... strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The… more
    Providence (01/01/26)
    - Related Jobs
  • Utilization Review Nurse

    Actalent (Rancho Cordova, CA)
    Utilization Review Nurse About the Role...2-3 years of clinical experience in prior authorization, case management , or utilization management + ... We're looking for a Utilization Review (UR) Nurse to join our...obtain additional clinical information when needed + Support denial management , including appeals and peer‑to‑peer review processes… more
    Actalent (12/24/25)
    - Related Jobs
  • RN Utilization Review Full- time…

    Providence (Mission Hills, CA)
    …strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The ... reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers,... Utilization Management RN must effectively and efficiently manage a diverse… more
    Providence (12/16/25)
    - Related Jobs
  • Registered Nurse - Utilization

    Cedars-Sinai (Los Angeles, CA)
    …named us one of America's Best Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent ... **Req ID** : 14355 **Working Title** : Registered Nurse - Utilization Review Case Manager - 8 Hour... Case Manager - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
    Cedars-Sinai (01/02/26)
    - Related Jobs
  • Utilization Review Specialist

    TEKsystems (Los Angeles, CA)
    …Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims ... Job Title: Retro Claims Reviewer Location: West Hills/Canoga Park 91305 Compensation: LVN...RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with… more
    TEKsystems (12/31/25)
    - Related Jobs