• Utilization Management Administration…

    Humana (Sacramento, CA)
    …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
    Humana (08/23/25)
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  • Utilization Management Registered Nurse

    Humana (Sacramento, CA)
    …a team **Preferred Qualifications** + Bachelor's degree + Previous experience in prior authorization, claims, and/or utilization management in healthcare, health ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
    Humana (09/04/25)
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  • Utilization Management Nurse Consultant

    CVS Health (Sacramento, CA)
    …5 years of relevant experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong ... that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key… more
    CVS Health (08/31/25)
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  • Senior Analyst, Client Analytics

    Evolent (Sacramento, CA)
    …and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and key ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… more
    Evolent (08/26/25)
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  • UM LVN

    Dignity Health (Bakersfield, CA)
    …to patient information, PHI and HIPAA regulations. **Preferred Qualifications:** - Prior Utilization Management (UM) experience strongly preferred. - Bachelor's ... as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the adverse… more
    Dignity Health (07/13/25)
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  • Per Diem Registered Nurse II/III…

    Ventura County (Ventura, CA)
    Per Diem Registered Nurse II/III - Utilization Management VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply  Per Diem ... Registered Nurse II/III - Utilization Management VCMC Salary $109,727.64 - $184,627.89 Annually Location...Must possess a valid Basic Life Support (BLS/CPR) Certificate PRIOR to the first day of employment. *These competency… more
    Ventura County (09/05/25)
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  • Utilization Review Nurse Supervisor II

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply  UTILIZATION REVIEW NURSE SUPERVISOR ... service are met and is subject to closure without prior notice. ABOUT LOS ANGELES COUNTY DEPARTMENT OF HEALTH...and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center,… more
    The County of Los Angeles (06/28/25)
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  • Staff Utilization Management Pharmacist…

    Humana (Sacramento, CA)
    …of our caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical ... necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying… more
    Humana (08/27/25)
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  • Director of Case Management - Utilization…

    Prime Healthcare (Inglewood, CA)
    …and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive ... case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Additionally,… more
    Prime Healthcare (08/26/25)
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  • Utilization Review Clinician - ABA

    Centene Corporation (Sacramento, CA)
    …(BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness in ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...to members and their families regrading ABA and BH utilization process + Provides feedback to leadership on opportunities… more
    Centene Corporation (08/09/25)
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