NewTravel Nurse RN - Utilization Review - $2,248 to $2,343 per week in Marina del Rey, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $2,248 to $2,343 per week in Marina del Rey, CAMarina del Rey, CA$2,248–$2,343As 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.
NewTravel Nurse RN - Utilization Review - $1,948 to $2,043 per week in Mission Viejo, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $1,948 to $2,043 per week in Mission Viejo, CAMission Viejo, CA$1,948–$2,043As 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.
NewTravel Nurse RN - Utilization Review - $2,065 to $2,160 per week in Mission Viejo, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $2,065 to $2,160 per week in Mission Viejo, CAMission Viejo, CA$2,065–$2,160As 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.
Grievance and Appeals Nurse Specialist (LVN or RN) Kinetic Personnel GroupGrievance and Appeals Nurse Specialist (LVN or RN)Orange, CA$43–$65 / hourTemporaryUtilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment. A permanent position does include excellent CalPERS pension, 401a (4% contribution) and excellent government benefits and Holiday/PTO schedule.
NewTravel RN Case Manager - $2,640 per week LanceSoftTravel RN Case Manager - $2,640 per weekSanta Monica, CALanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.
NewTravel Home Health Registered Nurse - $2,425 per week Skyline Med Staff Home HealthTravel Home Health Registered Nurse - $2,425 per weekTorrance, CAMinimum of 1 year recent work experience in the specialty of the job applying for 2. A current BLS/CPR certification through American Heart Association 3. Active License in the state of the job location We look forward to connecting and working with you to find your next job opportunity! Skyline Med Staff was named as the #1 Best Travel Healthcare Company in 2025 by BluePipes, a recognition driven by glowing reviews from travel healthcare professionals.
NewTravel Cath Lab RN - $2,467 per week Skyline Med Staff Home HealthTravel Cath Lab RN - $2,467 per weekLos Angeles, CAMinimum of 1 year recent work experience in the specialty of the job applying for 2. A current BLS/CPR certification through American Heart Association 3. Active License in the state of the job location We look forward to connecting and working with you to find your next job opportunity! Skyline Med Staff was named as the #1 Best Travel Healthcare Company in 2025 by BluePipes, a recognition driven by glowing reviews from travel healthcare professionals.
NewTravel RN Case Manager - $2,772 per week Prime StaffingTravel RN Case Manager - $2,772 per weekMission Viejo, CAID: 62855832 Shift: Day 5x8-Hour (08:00 - 16:30) Description: Job Description Start date: ASAP Floating Expectation: Float to the Laguna Facility Ratios: 1:25 Years of experience REQ: 2-year acute medical Care Manager experience performing Care Coordination First-timers accepted: No - requires travel experience, HARDSTOP Weekend REQ: Weekend Rotation CA state license: Yes Pending License accepted: Yes, but must be licensed upon start date RTO Restrictions: No more than 7 daysHospital Highlights Type of Facility: Acute Care Facility Scrub Color: Turquoise or Business Casual Modified Time:8/17/2026 12:00:00 AM Account Manager: Jordan Hinojos Account Manager Email: COVID-19 Vaccine: Not Required Flu Vaccine: Unknown Submittals:Low Job Requirements & Qualifications Previous Charge Experience: - Years of Experience: 2 Patient Ratio Experience: Charting System Experience: Required Charting System Name: Epic Community Hospital Experience: - LTAC Experience: - Trauma Level I Experience: Preferred Trauma Level II Experience: Preferred Travel Experience Required: Yes Certifications: Skills: Acute Hospital, Appeals and Denials, Care coordination, CMS: Centers for Medicare and Medicaid Services, Department of Health, Disability case management, Discharge Planning, Disease management, DRG (Diagnosis Related Groups), Emergency Department*, HIPAA guidelines (Health Insurance Portability and Accountability Act), ICU*, MS, Needs Assessment/ Order DME, OSHA, Plan of Care, Surgical Services*, The Joint Commission/ Core Measure/National Safety Goals, Worker s comp case management, Workers Compensation, extra checklist required, Epic Unit Details Staffing & Scheduling Scheduling Type: Other Patient Ratios Days: 25 Patient Ratios Nights: - Patient Ratios Weekends: - Float Required: - Call Required: - Weekend Coverage: True Number of Weekend Shifts Per Contract: varies to meet dept needscase load does increase on weekends depending on census Pre-Approved Time Off: one Orientation Hours: 40 Facility & Patient Care Details Patient Age Groups: Adults, Geriatrics Daily Census: up to 25 Number of Visits Per Day: - Number of Rooms: - Number of Beds: - Additional Unit Information Interdisciplinary Support: - Patient Diagnoses: Epic is a hardstop requirementCASE MANAGERS DO NOT DO UTILIZATION REVIEW Special Procedures/Unit Details: Experience with Assessing patients, Care Coordination, and Discharge Planning. Over 20 hours requires PM approval Modules are completed pre-start, and annually Time spent on modules is self-reported, completion is recorded in Workramp transcripts Submittal Details: #Tier3 Travel ComplianceWe must have these three things before your traveler can be reviewed by our clinical team so please submit with this information included:What is their upcoming interview availability?.Please confirm the DOB and full SSN is correct in Connect.
NewTravel Oncology Clinic Registered Nurse - $2,711 per week Catalytic SolutionsTravel Oncology Clinic Registered Nurse - $2,711 per weekLos Angeles, CAShift: Day 5x8-Hour (08:30 - 17:00) - Comfortably manage diverse patient age groups: Adolescents, Adults, Pediatrics, Geriatrics - Daily Census: Care for approximately 260 patients in a vibrant environment with 41 rooms - Collaborate with interdisciplinary support teams: IV, Interpretation Services, Phlebotomy, Radiology, Social Services, Lift Teams, Rapid Response Teams, Pharmacy, Transportation, and Unit Secretary - Responsibilities include: - Ambulatory practice management for efficient clinic flow - Conduct thorough nursing assessments and interventions - Manage new patient records for timely physician review - Telephone triage: Provide support and guidance to clinic patients - Educate patients and families on treatment plans, medications, side effects of chemo/surgery/BMT/CARt - Administer IM and SC chemotherapy injections - Work with CADD pumps for continuous infusions - Access, de-access, and troubleshoot PAS-ports and chest ports - Assist physicians with minor surgical procedures in office settings (e.g., excisional biopsies, JP drain/wound vacuum care) - Job Requirements: - 2 years of ambulatory oncology RN experience with strong chemotherapy knowledge - Current CA RN License required - BLS Certification required; Chemo Certification preferred - First-time travelers accepted with a minimum of 3 years of oncology experience - Special requirements: Oncology, chemotherapy, and surgical experience needed for triaging and post-op patient calls - No weekend shifts or floating needed! We partner with top healthcare systems nationwide to deliver high-quality travel nurses and allied professionals at competitive rates—while ensuring our clinicians earn industry-leading pay packages.
Dialysis Registered Nurse - PT U.S. Renal CareDialysis Registered Nurse - PTBeverly Hills, CA$41.89–$62.84As 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.
Dialysis Registered Nurse U.S. Renal CareDialysis Registered NurseLos Angeles, CA$40.48–$60.71As 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.
NewTravel Cath Lab RN - $2,494 per week GLC On-The-GoTravel Cath Lab RN - $2,494 per weekLos Angeles, CA$2,370–$2,494 / weekWe specialize in connecting travel nurses and allied healthcare professionals like you with opportunities in acute care, long-term care, behavioral health, and allied fields across the U.S. Apply now and start your rewarding journey with GLC - a recruiter will connect quickly to review pay, start date, and assignment details so you can make the best decision for your next contract.
NewTravel Labor and Delivery RN - $3,076 per week GLC On-The-GoTravel Labor and Delivery RN - $3,076 per weekLos Angeles, CA$2,922–$3,076 / weekWe specialize in connecting travel nurses and allied healthcare professionals like you with opportunities in acute care, long-term care, behavioral health, and allied fields across the U.S. Apply now and start your rewarding journey with GLC - a recruiter will connect quickly to review pay, start date, and assignment details so you can make the best decision for your next contract.
NewTravel Nurse RN - Nurse Manager - $2,151 per week in Los Angeles, CA TravelNurseSourceTravel Nurse RN - Nurse Manager - $2,151 per week in Los Angeles, CALos Angeles, CA$2,151Job Title: Emergency Department Nurse Lead Profession: RN Specialty: Nurse Lead Duration: 13 weeks Shift: Night Shift Hours per Shift: 36 hours Experience: Minimum five years of technical experience preferred License: Registered Nurse (RN) licensure in the state of practice required Certifications: Cardiopulmonary Resuscitation (CPR) certification or Basic Life Support (BLS) certification preferred Must-Have: Supervisory experience or demonstrated supervisory skills required Description: Provides unit-based leadership working collaboratively with the Nurse Manager, Director, Physicians, and staff. Ensures that all patients receive cost-effective, professional care that results in positive outcomes and high patient satisfaction while maintaining the highest level of patient safety.
NewSRS - Lead – RN - Pediatrics - Full Time - Day Shift SHARP HEALTHCARESRS - Lead – RN - Pediatrics - Full Time - Day ShiftOrange, CA$53,200–$63,840 / yearThe 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.
NewCertified Registered Nurse Anesthetist (CRNA), South Bay/Harbor City (Full Time) Kaiser PermanenteCertified Registered Nurse Anesthetist (CRNA), South Bay/Harbor City (Full Time)Harbor City, CASuch intervention may include, but not be limited to: airway management; maintenance of fluid balance; homeostasis; monitoring; response to emergencies related to airway management and cardiopulmonary resuscitation; and management of patients on ventilators. Demonstrates an understanding of the cognitive, physical, emotional and chronological maturation process in delivery of services to patients of each age group served: neonatal, pediatric, adolescent, adult and geriatric.
NewCertified Registered Nurse Anesthetist (CRNA), Los Angeles (Full Time) Kaiser PermanenteCertified Registered Nurse Anesthetist (CRNA), Los Angeles (Full Time)Los Angeles, CASuch intervention may include, but not be limited to: airway management; maintenance of fluid balance; homeostasis; monitoring; response to emergencies related to airway management and cardiopulmonary resuscitation; and management of patients on ventilators. Demonstrates an understanding of the cognitive, physical, emotional and chronological maturation process in delivery of services to patients of each age group served: neonatal, pediatric, adolescent, adult and geriatric.
NewCertified Registered Nurse Anesthetist (CRNA), Panorama City (Full Time) Kaiser PermanenteCertified Registered Nurse Anesthetist (CRNA), Panorama City (Full Time)Panorama City, CASuch intervention may include, but not be limited to: airway management; maintenance of fluid balance; homeostasis; monitoring; response to emergencies related to airway management and cardiopulmonary resuscitation; and management of patients on ventilators. Demonstrates an understanding of the cognitive, physical, emotional and chronological maturation process in delivery of services to patients of each age group served: neonatal, pediatric, adolescent, adult and geriatric.
NewCertified Registered Nurse Anesthetist (CRNA), Downey (Full Time) Kaiser PermanenteCertified Registered Nurse Anesthetist (CRNA), Downey (Full Time)Downey, CASuch intervention may include, but not be limited to: airway management; maintenance of fluid balance; homeostasis; monitoring; response to emergencies related to airway management and cardiopulmonary resuscitation; and management of patients on ventilators. Demonstrates an understanding of the cognitive, physical, emotional and chronological maturation process in delivery of services to patients of each age group served: neonatal, pediatric, adolescent, adult and geriatric.
New(RN) Remote Care Review Clinician - Utilization Review (Wknd role) Molina Healthcare Inc(RN) Remote Care Review Clinician - Utilization Review (Wknd role)CARemoteResponsible 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.
NewInpatient Review Nurse (Remote | California RN/LVN License Required | Pacific Time Schedule) Alignment Healthcare IncInpatient Review Nurse (Remote | California RN/LVN License Required | Pacific Time Schedule)CARemote$77,905–$116,858 / yearAs an inpatient review nurse, you will assist patients through the continuum of care in collaboration with the patient's primary care physician, facility case manager, discharge planner and employing contracted ancillary service providers and community resources as needed. Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.
Facility Site Review Nurse UCLA Health SystemFacility Site Review NurseLos Angeles, CA$37.60–$78.35 / hourAs 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. The Facility Site Review Nurse serves as a key liaison between provider sites, clinic leadership, office staff, contracted health plans, and other stakeholders to ensure compliance and support performance improvement initiatives.
Utlization Review RN eTeam Inc.Utlization Review RNOrange, CA$60–$65 / hourCandidate 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.
Clinical Review Nurse - Prior Authorization AkidoClinical Review Nurse - Prior AuthorizationChino, CA$62,400–$93,600 / yearServing 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.
NewInpatient Review Nurse (Remote | California RN/LVN License Required | Part-Time | Weekends | Pacific Time Schedule) Alignment Healthcare IncInpatient Review Nurse (Remote | California RN/LVN License Required | Part-Time | Weekends | Pacific Time Schedule)CARemote$77,905–$116,858 / yearEffective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly. Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
(RN) Appeals Medical Review Nurse - REMOTE Molina Healthcare Inc(RN) Appeals Medical Review Nurse - REMOTECARemoteREQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
UM Review Nurse - LVN Astrana Health IncUM Review Nurse - LVNMonterey Park, CARemoteIn this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. We are seeking nurses with at least one year of outpatient UM experience in a fast-paced setting.
UM Review Nurse Astrana Health IncUM Review NurseMonterey Park, CARemoteIn this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting.
Senior Clinical Utilization Review Nurse I Kaiser PermanenteSenior Clinical Utilization Review Nurse IPasadena, CAFacilitates quality improvement efforts by: conducting advanced data analyses and developing reports to identify utilization patterns, trends, and opportunities for improvement; providing input and participating in the implementation of corrective action plans to address deficiencies and evaluate effectiveness in utilization review workflows/processes; actively adhering to utilization policies, procedures, and guidelines to ensure compliant and cost-effective care; and developing, refining, and providing oversight for desk-level procedures (e.g., workflows). + Provides high-quality consultation by: leading communication efforts with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care and resolving communication issues within the work team; and leveraging advanced knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians.
LVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Emanate Health Medical CenterLVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hrCovina, CA$31.03–$46.54 / hourComplete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings. On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.
RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Emanate Health Medical CenterRN - Quality Assurance/Utilization Review - Business Development - Full Time 8hrCovina, CA$52.03–$80.64 / hourComplete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings. On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.
Utilization Review LPN LVN - Utilization Management Providence Health & ServicesUtilization Review LPN LVN - Utilization ManagementMission Hills, CATogether, 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. Required Qualifications: Associate''s Degree in Healthcare or high school diploma or GED with graduation from an accredited nursing program from a college or vocational school with 2 years' related work experience.
Utilization Review LPN LVN - Utilization Management Providence St. Joseph HealthUtilization Review LPN LVN - Utilization ManagementMission Hills, CATogether, 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. Required Qualifications: Associate''s Degree in Healthcare or high school diploma or GED with graduation from an accredited nursing program from a college or vocational school with 2 years' related work experience.
Care Review Clinician (RN) Remote Molina Healthcare IncCare Review Clinician (RN) RemoteCARemoteResponsible 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.
Care Review Clinician (RN) - Reside in PST Molina Healthcare IncCare Review Clinician (RN) - Reside in PSTCAResponsible 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.
RN Case Manager Utilization Review Prime Healthcare Services IncRN Case Manager Utilization ReviewLynwood, CA$47.20–$63.45 / hourRequired Qualifications: Minimum 5 years'' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license At least one year experience in case management, discharge planning or nursing management Experience and knowledge in basic to intermediate computer skills. The methodology is designed to facilitate and ensure 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.
RN Case Manager - Utilization Review St. Francis Medical CenterRN Case Manager - Utilization ReviewLynwood, California$47.20–$63.45 / hourFull timeThe methodology is designed to facilitate and ensure 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. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Facility Site Review Nurse University of CaliforniaFacility Site Review NurseLos Angeles, CA$37.60–$78.35 / hourAs 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. The Facility Site Review Nurse serves as a key liaison between provider sites, clinic leadership, office staff, contracted health plans, and other stakeholders to ensure compliance and support performance improvement initiatives.
NewCare Review Clinician (RN) Molina Healthcare IncCare Review Clinician (RN)Long Beach, CAResponsible 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.
UM Review Nurse Astrana Health, Inc.UM Review NurseMonterey Park, CaliforniaRemote$34–$47 / hourComplete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans.
RN Utilization Review - Per Diem - REMOTE Providence Health & ServicesRN Utilization Review - Per Diem - REMOTEIrvine, CARemote$57.28–$88.92 / hourRequsition 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.
RN Utilization Review - Per Diem - REMOTE Providence St. Joseph HealthRN Utilization Review - Per Diem - REMOTEIrvine, CARemoteThe 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.
Utilization Management Nurse, Senior- Medicare Concurrent Review Blue Cross and Blue Shield AssociationUtilization Management Nurse, Senior- Medicare Concurrent ReviewWoodland Hills, CARequires a current California RN License Requires at least 5 years of prior relevant experience Requires strong communication and computer navigation skills Desires strong teamwork and collaboration skills Requires independent motivation and strong work ethic Requires strong critical thinking skills Hybrid Virtual Work This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need. Your Work In this role, you will: Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC and CMS evidenced based guidelines, policies and nationally recognized clinal criteria for BSC Medicare line of business.
Registered Nurse/Utilization Review APN Consulting IncRegistered Nurse/Utilization ReviewOrange, CACandidate must be highly proficient in EPIC and InterQual, with demonstrated experience using both systems for clinical review and medical necessity determination. Observed Holidays: New Year's Day: Falls Within: 7:00 PM day before - 7:00 AM day after.
Registered Nurse - Utilization Review Case Manager - PER_DIEM - 8 Hour Days Cedars-Sinai Medical CenterRegistered Nurse - Utilization Review Case Manager - PER_DIEM - 8 Hour DaysLos Angeles, CAFor this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment. This shared culture of happiness, passion and dedication pulses through Cedars-Sinai, and it's just one of the many reasons we've achieved our fifth consecutive Magnet designation for nursing excellence.
Clinical Review Clinician Appeals RN Centene Corporation GroupClinical Review Clinician Appeals RNCA$27.02–$48.55 / hourEducation/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.
Manager, Clinical Case Review Edwards LifesciencesManager, Clinical Case ReviewIrvine, CAThe 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.
Specialist, Facility Site Review (must reside in California) Molina Healthcare IncSpecialist, Facility Site Review (must reside in California)Los Angeles, CAProvides support for facility site review activities including routine document preparation and file management, site review meeting/travel scheduling, and office supply ordering. Conducts outreach to providers to schedule facility site reviews; leverages established departmental workflows and job aids in all outreach efforts.
Clinical Data Review Coordinator UCLA Health SystemClinical Data Review CoordinatorSanta Monica, CA$54,400–$208,300 / yearAs 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. Your work ensures that the data driving our quality metrics is reliable, actionable, and aligned with regulatory expectations-ultimately supporting better outcomes for the patients and communities we serve.
Itemized Bill Review Auditor III (IBR) ExlService Holdings IncItemized Bill Review Auditor III (IBR)CA$70,000–$90,000 / yearEXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others.