• Care Manager RN - Utilization

    Providence (Napa, CA)
    **Description** Care Manager RN - Utilization Review unit at Providence Queen of the Valley Medical Center in Napa, CA. This position is Full-Time and ... the continuum of care . The RN Case Manager assists patients in the utilization of...time **Job Shift:** Day **Career Track:** Nursing **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas… more
    Providence (08/08/25)
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  • System Utilization Management SUM…

    Alameda Health System (Oakland, CA)
    …trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care ) by participating in appropriate ... System Utilization Management SUM Utilization Review...in orientation of fresh staff as requested by the Manager of Utilization Management. 17. Maintains knowledge… more
    Alameda Health System (08/22/25)
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  • RN Case Manager - Denials, Discharge…

    Amergis (French Camp, CA)
    …Week The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, ... service delivery, and compliance with medical regime. Minimum Requirements: + Current RN licensure in state practicing + At least one year of Case Management experience preferred + Current CPR if applicable + TB questionnaire, PPD or chest x-ray if applicable… more
    Amergis (08/22/25)
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  • Utilization Review LVN

    Dignity Health (Woodland, CA)
    …Woodland, CA, with occasional onsite meetings in Woodland.** **Position Summary:** The Utilization Review LVN uses clinical judgement in providing utilization ... management services. The focus is to provide high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving … more
    Dignity Health (08/14/25)
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  • Utilization Management Admissions Liaison…

    LA Care Health Plan (Los Angeles, CA)
    … Management Medical Director, on requests where determination requires extended review . Collaborates with the inpatient care team for facilitation/coordination ... Utilization Management Admissions Liaison RN II Job Category:...participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care more
    LA Care Health Plan (08/02/25)
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  • Case Manager (RN) - Utilization

    Prime Healthcare (Chino, CA)
    …school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing experience preferred. At least ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/219949/case- manager -%28rn%29 utilization more
    Prime Healthcare (08/14/25)
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  • Case Manager - Utilization

    Prime Healthcare (Anaheim, CA)
    …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/218947/case- manager utilization ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...skills. Preferred qualifications: 1. Minimum 5 years of acute care experience preferred.2. Certified Case Manager (CCM)… more
    Prime Healthcare (08/08/25)
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  • Case Manager (RN) - Utilization

    Prime Healthcare (San Dimas, CA)
    …school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing experience preferred. At least ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/214914/case- manager -%28rn%29 utilization more
    Prime Healthcare (07/15/25)
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  • Utilization Management LVN (Remote - CA…

    Actalent (Redlands, CA)
    …internal staff to ensure seamless care coordination. Essential Skills + Utilization review and management experience. + Familiarity with Medicare, MediCal, ... Job Title: Remote LVN Case Manager - Utilization Management Job Description...clinical advanced degree preferred. + 1+ year of managed care experience preferred. + 1+ year of inpatient experience… more
    Actalent (08/21/25)
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  • Utilization Management Nurse

    CenterWell (Sacramento, CA)
    …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience +… more
    CenterWell (08/02/25)
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