• Clinical UM Nurse 2

    CenterWell (Sacramento, CA)
    …of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent ... your skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non… more
    CenterWell (09/26/25)
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  • Nurse Supervisor, Healthcare Services…

    Molina Healthcare (Los Angeles, CA)
    …Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes. * Medicaid/Medicare population experience. * Clinical experience. ... least 5 years health care experience, and at least 2 years of managed care experienced utilization management. *...in good standing. **Preferred Qualifications** * LVN (Licensed vocational nurse ) or RN (Registered Nurse ) . License… more
    Molina Healthcare (09/25/25)
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  • Enhanced Care Management Clinical…

    LA Care Health Plan (Los Angeles, CA)
    Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get...that purpose. Job Summary The Enhanced Care Management (ECM) Clinical Specialist II is responsible for the management and… more
    LA Care Health Plan (07/16/25)
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  • Utilization Management Admissions Liaison RN II

    LA Care Health Plan (Los Angeles, CA)
    …for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse (RN) - Active, ... Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full… more
    LA Care Health Plan (10/03/25)
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  • Manager Integrated Case Mgmt-SCMG…

    Sharp HealthCare (San Diego, CA)
    …Time** Bachelor's Degree in Nursing; Bachelor's Degree; Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Professional in ... improvement as a representative of SCMG. Provides support to the VP for Clinical Operations and HS leadership team to ensure regulatory and legislative compliance… more
    Sharp HealthCare (08/29/25)
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  • RN, Manager, Utilization Management Nursing

    Humana (Sacramento, CA)
    …for providing leadership and oversight of the physical health utilization management ( UM ) staff in daily operations. + Uses clinical knowledge, communication ... Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical nursing skills to support the coordination, documentation and… more
    Humana (09/28/25)
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  • Care Review Clinician (RN) California

    Molina Healthcare (Los Angeles, CA)
    California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 DAY SHIFT 7:30AM - 08:30PM PACIFIC HOURS NON EXEMPT, 3 days a week will ... rotate._** **_TRAINING SCHEDULE WILL BE Monday thru Friday 8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift… more
    Molina Healthcare (09/06/25)
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  • RN Care Coordinator - Inpatient Specialty Program…

    Cedars-Sinai (Beverly Hills, CA)
    …nursing (Medical Surgical/Tele/ICU) with 2 or more year of care management experience ( UM or DC Planning). + 1 year of previous experience in case management in ... care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to… more
    Cedars-Sinai (09/28/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (San Francisco, CA)
    …daytime hours.** **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that ... services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes… more
    Molina Healthcare (08/24/25)
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  • Medical Director ( CA)

    Molina Healthcare (San Bernardino, CA)
    …at the most effective setting. *Evaluates effectiveness of utilization management ( UM ) practices - actively monitoring for over and under-utilization. * Educates ... and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical … more
    Molina Healthcare (10/02/25)
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