• Utilization Review Nurse

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR...CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board ... II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply  UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 -… more
    The County of Los Angeles (03/30/25)
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  • System Utilization Management SUM…

    Alameda Health System (Oakland, CA)
    System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Services As Needed / ... **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
    Alameda Health System (05/06/25)
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  • System Educator Care Coordination/…

    Alameda Health System (Oakland, CA)
    System Educator Care Coordination/ Utilization Review + Oakland, CA + Highland General Hospital + SYS Care Coordination + Full Time - Day + Care Management + Req ... 2025 **Summary** **Role Overview:** The System Educator of Care Coordination and Utilization Review is responsible for developing, implementing, and maintaining… more
    Alameda Health System (05/06/25)
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  • RN - Quality Assurance/ Utilization

    Emanate Health (Covina, CA)
    …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity… more
    Emanate Health (04/23/25)
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  • Utilization Review RN

    Dignity Health (Santa Maria, CA)
    …Abilities, and Training** * Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used * Proficient in application of clinical ... **Responsibilities** **JOB SUMMARY / PURPOSE** Responsible for the review of medical records for appropriate admission status and continued hospitalization. Work… more
    Dignity Health (04/14/25)
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  • Case Manager, RN - Utilization

    Prime Healthcare (Lynwood, CA)
    …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/204105/case-manager%2c- rn utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April… more
    Prime Healthcare (04/17/25)
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  • Director, Utilization Management

    Alameda Health System (Oakland, CA)
    …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
    Alameda Health System (05/06/25)
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  • Manager, Care Coordination ( RN )…

    Stanford Health Care (Palo Alto, CA)
    …years of experience as an RN - 3+ years of experience in case management/ utilization review Why work at Stanford Medicine | Stanford Health Care (SHC)? - ... Knowledge of principles and best practices of case management, utilization review , social work, care coordination and...to address them. **Licenses and Certifications** + Nursing / RN - Registered Nurse -… more
    Stanford Health Care (02/22/25)
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  • Utilization Management Manager, Medicare…

    UCLA Health (Los Angeles, CA)
    …+ experience in an HMO environment + Thorough knowledge of health care industry, utilization review , utilization management, and concurrent review ... all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM coordinators and… more
    UCLA Health (03/04/25)
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  • Corporate Director of Clinical Utilization

    Prime Healthcare (Ontario, CA)
    …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with...with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA)… more
    Prime Healthcare (04/17/25)
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