589 Results for

Review Nurse Jobs in Lakewood, CA

Jobs

New!

Mission Viejo, CA3 days ago

$1,948–$2,043

As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.

New!

Los Angeles, CA3 days ago

$2,065–$2,160

New!

Mission Viejo, CA3 days ago

$2,065–$2,160

Torrance, CA30+ days ago

$1,917–$1,917

This includes offering exceptional pay packages along with these great benefits: Medical, dental, and vision insurance. NTG is committed to matching you to the right position and we pride ourselves on our commitment to our travelers.

Alhambra, CA30+ days ago

Full-time
Employee

Monitors nursing and medical plans of care/discharge plans and provides appropriate interventions to assure care is appropriate, coordinated and that avoidable patient days are addressed effectively through education, consultation, and counseling as needed. Ensures collaboration between multidisciplinary healthcare team members, primary physician, community agencies, HMOs/PPOs, CCS, etc., whose services may be required and/or related to the care needs of the patient after hospital discharge.

New!

Mission Hills, CA2 days ago

$2,283–$2,624

Assist in arterial and/or venous sheath removal using closure devices, manual pressure, or mechanical compression, and transport patients to the appropriate recovery area . Technical/Motor Skills - Must have the ability to grasp, perform fine manipulation, push/pull, and move about when assisting with procedures and/or using department equipment .

Los Angeles, CA7 days ago

$200,000–$240,000 Per Year

The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. Demonstrates typing skills proficiency by: Using a keyboard, required to type proficiently and accurately; Have the ability to type a minimum of 30 words per minute with 0-2 errors; Have the ability to proof work.

New!

Pomona, CA4 days ago

$76,544–$131,372.76 Per Year

San Gabriel/Pomona Regional Center (SG/PRC) is a private, nonprofit agency contracted with the California Department of Developmental Services (DDS) to provide services and supports to individuals with intellectual and developmental disabilities. Core responsibilities include assessments, evaluations, consultations, and delivery of high-quality care, ensuring individuals served receive appropriate medical care and that staff and families are well-informed and supported in managing health needs.

Van Nuys, CA8 days ago

$40.48–$60.71

As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease. You'll ensure quality renal care by completing monthly reviews of patient medication profiles and administering medications according to physician orders.

Alhambra, CA30+ days ago

Full-time
Employee

Job Description: In the UM department, Case Management Coordinator is to assist with the coordinating of the day-to day activities in the medical group, request for authorization for ancillary services, and certify the group is utilizing the most cost effective provider. Also, identify patients found in out-of-network facilities and send the information timely to the concurrent-review nurse for coordination with the hospital and group.

New!

Whittier, CA1 day ago

$55–$87.50 Per Hour

The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology.

New!

Bell Gardens, CA1 day ago

Job Requirements: Education and Work Experience: Bachelor's Degree in Nursing (BSN): Preferred Experience in a care management role: Preferred Licenses/Certifications: Registered Nurse (RN) licensure in the state of practice: Required Case management certification: Preferred Essential Functions: Leads the coordination of patient care with other disciplines within the care team, monitoring the appropriateness and timeliness of care. Ensures the interdisciplinary care plan is consistent with the patient's clinical course, continuing care needs and covered services by monitoring diagnostic testing, treatments and procedures, and other aspects of patient care as appropriate for acute care.

New!

Glendale, CA2 days ago

Job Requirements: Education and Work Experience: Bachelor's Degree in nursing or equivalent combination of education/related experience: Required Master's Degree: Preferred Five years' technical experience: Preferred One year's leadership experience: Preferred Two years' experience of acute care nursing in hospital setting: Preferred Licenses/Certifications: Registered Nurse (RN) licensure in the state of practice: Required Cardiopulmonary Resuscitation (CPR) or Basic Life Support (BLS OR HS-BLS OR RQIBLS) certification: Preferred National specialty certification in area of expertise or in nursing administration: Preferred Facility Specific License/Certifications: Basic Life Support (BLS OR HS-BLS OR RQI BLS) certification: Required Essential Functions: Builds a high performing clinical work team by recruiting and retaining skilled professional staff. Initiates and coordinates individual and team conferences with health team members, patients, and/or families to initiate and revise care plans for optimal, individualized patient care as per care setting.

Los Angeles, CA30+ days ago

$118,457.04–$177,314.88 Per Year

Veteran's Credit: Pursuant to the County Charter and County policy, in all open competitive examinations (i.e., examinations open to everyone), the County of Los Angeles will add a credit of 10 percent of the total credits specified for such examination to the final passing score of an honorably discharged veteran, as well as the spouse of a deceased or disabled veteran, who served in the Armed Forces of the United States under specific conditions. Under the direction of a physician member of the Utilization Review Committee, the incumbent is responsible for the development and implementation of procedures for and the effective conduct of the system to review patients medical charts to ascertain the medical necessity for services and appropriateness of the level of care, for notification of appropriate persons of cases which do not meet medical necessity and level of care criteria, and for certification of approved hospital days reimbursable under the Medicare and MediCal programs.

Orange, CA30+ days ago

Candidate must be highly proficient in EPIC and InterQual, with demonstrated experience using both systems for clinical review and medical necessity determination. Shift: Day 5x8-Hour (09:00 - 17:30) .

New!

Los Angeles, CA1 day ago

$74,286.15–$111,429.23 Per Year

By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid. This role involves assessing inpatient admission and continued stays, coordinating with healthcare providers, facilitating communication with payers, and ensuring compliance with health plan policies and clinical guidelines.

Orange, CA30+ days ago

$60–$65 Per Hour

Candidate must be highly proficient in EPIC and InterQual, with demonstrated experience using both systems for clinical review and medical necessity determination. Pre-approved time off per contract no to exceed 5 days.

New!

Chino, CA1 day ago

$62,400–$93,600 Per Year

Serving 500K+ patients across California, Rhode Island, and New York, Akido offers primary and specialty care in 26 specialties—from serving unhoused communities in Los Angeles to ride-share drivers in New York. Akido is the first AI-native care provider, combining cutting-edge technology with a nationwide medical network to address America's physician shortage and make exceptional healthcare universal.

Mission Hills, CA12 days ago

$57.28–$88.92 Per Hour

Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Mission Hills, CA13 days ago

Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Whittier, CA30+ days ago

The EPR-RN performs, and supervises the EPRN-LVN, in utilization review with a prominent level of expertise by using approved criteria that demonstrates medical necessity to achieve appropriate authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, or Outpatient). The Emergency Prospective Review (EPR) Nurse RN has the responsibility to conduct a review of all patients requiring hospital admission from the emergency room at all PIH and non-PIH facilities (for PHP members) after stabilizing care has been initiated for medical necessity and appropriateness.

New!

Remote-CA, CA5 days ago

Remote

$27.02–$48.55 Per Hour

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines.

Lynwood, California11 days ago

$47.20–$63.45 Per Hour

The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the hospital for high quality and compassionate medical care.

New!

Irvine, CA6 days ago

Remote

$57.28–$88.92 Per Hour

Requsition ID: 437582 Company: Providence Jobs Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 7000 UTILIZATION MGMT OCHD Address: CA Irvine 15480 Laguna Canyon Rd Work Location: Providence System Offices Discovery Park-Irvine Workplace Type: Remote Pay Range: $57.28 - $88.92 Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.

Irvine, CA20 days ago

Remote

$57.28–$88.92 Per Hour

Requsition ID: 434193 Company: Providence Jobs Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Part time Job Shift: Multiple shifts available Career Track: Nursing Department: 7000 UTILIZATION MGMT OCHD Address: CA Irvine 15480 Laguna Canyon Rd Work Location: Providence System Offices Discovery Park-Irvine Workplace Type: On-site Pay Range: $57.28 - $88.92 Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.

Irvine, CA21 days ago

Remote

The Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.

New!

Irvine, CA6 days ago

Remote

los angeles, CA30+ days ago

$37.60–$78.35 Per Hour

In this role, you will supports all Medical Group Health Education & Disease Management Programs utilizing established interventions, performing necessary surveys acting as the primary liaison between providers and office staff and Health Plans to facilitate appropriate Health Education opportunities. Additionally, you will performs HEDIS related activities, Pay for Performance activities, Provider Access and Availability Surveys (PAAS), investigates and resolves access-related patient issues, and develops QI reports and action plans, as necessary.

Burbank, CA30+ days ago

Vivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States. Oversee both licensed and non-licensed denial unit staff, managing daily tasks, performance reviews, and any necessary disciplinary actions.

Burbank, CA30+ days ago

Vivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States. Supervise licensed and non-licensed denial unit staff, managing daily tasks, performance reviews, and disciplinary actions.

Bellflower, CA30+ days ago

The Utilization Review/Management Nurse is also responsible in performing and completing medical necessity reviews utilizing McG and Interqual Review Guidelines ensuring adherence to said guidelines for admission and continued stay reviews. Maintains open lines of communication with Case Managers and Discharge Coordinators to ensure patient's safe and timely transition to the next appropriate level of care based on identified post-acute services needed.

Los Angeles, Los Angeles County30+ days ago

$1,900–$2,500 Per Week

This role is crucial for ensuring that patients receive appropriate care while managing healthcare resources effectively. Communicate effectively with patients, families, and healthcare providers regarding care options and resources.

CA30+ days ago

$27.02–$48.55 Per Hour

Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience. Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices.

Los Angeles, CA30+ days ago

Remote

Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.

Long Beach, CA13 days ago

Demonstrated proficiency in at least three of the following: MEDICARE/MEDICARE STARS, Dual Special Needs Plan (D-SNP), MEDI-CAL, NCQA/URAC/Quality Programs, Policies/Procedure development, Clinical Subject Matter Expert for Litigation, SIU/Waste/Fraud/Abuse, Appeals/Grievances, Case Management/Population Health, Federal Employee Program (FEP), Education/Training (DELIVERS CME, CEU), Quality Improvement. Support Vice President, Medical Director in strategic initiatives whether by proposing clinical initiatives, providing expert input, shaping the strategy, and/or serving as the initiative driver.

New!

Los Angeles, CA6 days ago

Remote

$27.02–$48.55 Per Hour

RN - Registered Nurse - State Licensure and/or Compact State Licensure RN - Registered Nurse- State Licensure and/or Compact State Licensure with BCBA required or. Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services.

New!

Santa Ana, CA1 day ago

Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials and mailing/faxing appeals, tracking data from various insurance providers and health plans regarding authorization and/or denials, expedite reviews and documentation to insurance providers. Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plus .

Long Beach, CA30+ days ago

Remote

$43–$44 Per Hour

Description:The Care Review Clinician is responsible for performing utilization management (UM) reviews, including prior authorization of outpatient services, to ensure medical necessity, appropriate level of care, and compliance with regulatory and organizational guidelines. The clinician will review clinical documentation, apply evidence-based criteria, and collaborate with providers to facilitate timely and appropriate care for members.

Torrance, California30+ days ago

Remote

The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. With deep expertise in employee benefits, workers’ compensation, loss control, financial services, and property and liability programs, Keenan is dedicated to delivering innovative solutions that protect organizations and empower the communities they serve.

Irvine, CA30+ days ago

The Case Review Manager leads the patient screening analysis and evaluation of baseline medical history and clinical imaging reports (e.g EDC screening records including clinic notes, lab results, cardiology assessments, CT and/or echocardiogram reports) to confirm protocol compliance and provide patient screening and case review support to clinical trial sites for Clinical Research Trials within THV Clinical Affairs. + Previous related experience working a clinical setting or equivalent work experience based on Edwards criteria Preferred and Experience working in the setting of a clinical trial or equivalent work experience based on Edwards criteria Preferred.

Los Angeles, CA19 days ago

$74.16–$107.75 Per Hour

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New!

San Clemente, CA5 days ago

Understand and practice the proper method of attending to and disposing of and the possibility of exposure to blood borne pathogens, bodily fluids, infectious waste, sharp sticks, and hazardous materials in compliance with universal care precautions. Transcribe physician orders Medication Administration Record Treatment Administration Record (MAR/TAR) to include initials, date and time 'noted', and date faxed to pharmacy accurately and promptly.

New!

Los Angeles, CA1 day ago

$26.35–$39.53 Per Hour

West Hills, CA30+ days ago

Full-time

Care Plan Functions Assist in the development, implementation, and maintenance of a written plan of care (preliminary and comprehensive) for each resident in isolation or on infection control precautions that identifies the problems/needs of the resident, indicates the care to be given, goals to be accomplished, and which professional service is responsible for each element of care. Orient new employees to the importance of infection control policies and procedures, personal hygiene, handwashing/hand hygiene techniques, etc., as well as the employee's responsibility in following our established procedures for tasks involving exposure to blood/body fluids.

Los Angeles, CA14 days ago

$102,183–$132,838 Per Year

This role ensures that the day to day functions of Utilization Management initiatives comply with regulatory and accreditation requirements such as those stated in contracts, CalAIM Population Health Management (PHM) Policy Guide, National Committee on Quality Assurance (NCQA) Department of Health Care Services (DHCS) All Plan Letters (APLs), and Centers for Medicare and Medicaid Services (CMS) Model of Care (MOC) through sound clinical policy maintenance. Non-negotiable requirements of this position: Direct past experience with Health Care / Medical Policy work specifically within a Managed Care Plans environment; experience with the ongoing development of the Medical Policy review process including clinical and utilization data analysis; Assisted in developing training documents and presentations for new and/or revised Medical Policies to internal stakeholders.

los angeles, CA30+ days ago

$112,900–$256,900 Per Year

As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer. Named one of the top hospitals in the nation by U.S. News & World Report, UCLA Health features four award-winning hospitals and more than 250 community clinics throughout Southern California as well as the David Geffen School of Medicine.

Los Angeles, CA30+ days ago

For Inpatient RNs, performs unit based inpatient case management duties, with the ability to perform RN case management assessments, discharge planning, formulating safe plans of care and anticipating patient care needs. The incumbent consistently communicates and treats the Veteran and as appropriate the Veteran’s family, caregiver and/or significant other, the Veteran representatives, visitors to VA facilities, all VA staff, and other customers in a courteous, tactful, and respectful manner.

Irvine, CA11 days ago

Contractor

Skills/Experience Required: Acute Hospital; Long Term Acute Care/Rehab/Skilled Nursing; Admission Criteria; Care Coordination; Discharge Planning; Utilize InterQual Criteria; Utilize Milliman Guidelines; UR Admission Criteria; UR Appeals and Denials; UR Concurrent Review; UR Continued Stay Reviews; UR Medical Necessity; UR Retrospective Review; UR Utilize InterQual Criteria; UR Utilize Milliman Guidelines; CMS: Centers for Medicare and Medicaid Services; CPT (Current Procedural Terminology) coding and billing; Department of Health; DRG (Diagnosis Related Groups); HEDIS (The Healthcare Effectiveness Data and Information Set) Measures; HIPAA guidelines (Health Insurance Portability and Accountability Act); ICD 10 Coding; NCQA (National Committee for Quality Assurance); OSHA; The Joint Commission/ Core Measure/National Safety Goals. Description: Complex inpatient Case Manager and Utilization Review RN for Cancer Specialty Hospital.

Los Angeles, CA13 days ago

Additionally, they champion quality improvement initiatives, demonstrate leadership prowess, foster collaboration among peers, evaluate professional practice, optimize resource utilization, promote environmental health, and advocate for patients as integral components of clinical nursing practice. As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.

New!

Los Angeles, CA1 day ago

$27.10–$40.65 Per Hour

By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid. Working in collaboration with Medical Directors and the clinical team, the PA Nurse ensures members receive the appropriate benefit coverage for services requiring prior authorization.

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Review Nurse Jobs in Lakewood, CA

Travel Nurse RN - Utilization Review - $1,948 to $2,043 per week in Mission Viejo, CA TravelNurseSource

Travel Nurse RN - Utilization Review - $2,065 to $2,160 per week in Los Angeles, CA TravelNurseSource

Travel Nurse RN - Utilization Review - $2,065 to $2,160 per week in Mission Viejo, CA TravelNurseSource

Travel Nurse RN - Utilization Review - $1,917 per week in Torrance, CA Nationwide Therapy Group

Case Manager RN Health Source MSO

Travel Cath Lab RN Fusion Medical Staffing

SRS - Lead – RN - Pediatrics - Full Time - Day Shift SHARP HEALTHCARE

Nurse - Clinical Services San Gabriel/Pomona Regional Center

Dialysis Registered Nurse U.S. Renal Care

Case Management Coordinator Health Source MSO

RN PIH Health

RN - Lead Care Manager (Full-Time, Day Shift) Adventist Health

Manager RN - Operating Room (OR) Surgery, Full-Time, Day Shift Adventist Health

UTILIZATION REVIEW NURSE SUPERVISOR II Los Angeles County

Utilization Review RN eTeam Inc.

Concurrent Utilization Review Nurse, RN NeueHealth

Utlization Review RN eTeam Inc.

Clinical Review Nurse - Prior Authorization Akido

Utilization Review RN Providence Health & Services

Utilization Review RN Providence St. Joseph Health

Registered Nurse/Utilization Review APN Consulting Inc

Clinical Review Nurse - Concurrent Review (RN) Centene Corporation Group

RN Case Manager - Utilization Review St. Francis Medical Center

RN Utilization Review - Full-time - REMOTE Providence Health & Services

RN Utilization Review - Per Diem - REMOTE Providence Health & Services

RN Utilization Review - Per Diem - REMOTE Providence St. Joseph Health

RN Utilization Review - Full-time - REMOTE Providence St. Joseph Health

Quality Management Clinical Nurse - Facility Site Review UCLA Health System

Utilization Review Clinical Manager - Denials (Registered Nurse) Vivo HealthStaff

Utilization Review Clinical Supervisor - Denials (Registered Nurse) Vivo HealthStaff

RN Nurse Utilization Review - Full Time, Days (Los Angeles) NOR Healthcare Systems

Travel RN -Case Management Utilization Review Forhyre

Clinical Review Clinician Appeals RN Centene Corporation Group

RN- Care Review Clinician- Utilization Review (Remote- CA License Req) Molina Healthcare Inc

Medical Director, Utilization Management - Commercial Prior Authorization Review Blue Cross and Blue Shield Association

Utilization Review Clinician - ABA Centene Corporation Group

Utilization Review Tech KPC Global MSO

Care Review Clinician I Integrated Resources, Inc

Vice President, Bill Review and Managed Care Gallagher

Manager, Clinical Case Review Edwards Lifesciences

Utilization Management Nurse UCLA Health System

Wellness Nurse LPN LVN Sunrise Senior Living LLC

Utilization Management Nurse, LVN/LPN NeueHealth

IP Nurse West Valley Post Acute

Utilization Management Policy Initiatives Registered Nurse Macpower Digital Assets Edge Private Limited

Utilization Management Manager, Medicare Advantage - RN UCLA Health System

Utilization Management Nurse Presidential Staffing Solutions, LLC

Registered Nurse - Case Manager Apidel Technologies

RN Per Diem - Radiation Oncology - Ronald Reagan Medical Plaza UCLA Health System

Utilization Management Nurse, LVN/LPN (Work from Home) NeueHealth

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