TravelNurseSourceNewTravel Nurse RN - Utilization Review - $2,065 to $2,160 per week in Los Angeles, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $2,065 to $2,160 per week in Los Angeles, CALos Angeles, 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.
Nationwide Therapy GroupTravel Nurse RN - Utilization Review - $1,917 per week in Torrance, CA Nationwide Therapy GroupTravel Nurse RN - Utilization Review - $1,917 per week in Torrance, CATorrance, CA$1,917–$1,917This 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.
Health Source MSOCase Manager RN Health Source MSOCase Manager RNAlhambra, CAFull timeMonitors 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.
Providence Health and ServicesNewCare Manager RN - Medical Management Providence Health and ServicesCare Manager RN - Medical ManagementAnaheim, CA$57.28–$88.92 / hourTogether, 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. Providence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care.
SHARP HEALTHCARESRS - Lead – RN - Pediatrics - Full Time - Day Shift SHARP HEALTHCARESRS - Lead – RN - Pediatrics - Full Time - Day ShiftLos Angeles, CA$200,000–$240,000 / 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.
Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RNBellflower, CA$71,000–$166,000 / yearAs the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. We have a diverse range of employee resource groups (ERGs) to encourage employees with similar interests, goals, social and cultural backgrounds, or experiences to come together for professional and personal development, discussion, activities, and peer support.
PIH HealthNewRN PIH HealthRNWhittier, CA$55–$87.50 / hourThe 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.
Providence Health and ServicesNewCare Manager RN - MSO CM Heritage Per Diem Providence Health and ServicesCare Manager RN - MSO CM Heritage Per DiemMission Hills, CA$57.28–$88.92 / hourTogether, 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. Providence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care.
Providence Health and ServicesNewCare Manager RN Full- time Day Providence Health and ServicesCare Manager RN Full- time DayBurbank, CA$56.12–$84.75 / hourOur 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. All Registered Nurses without a minimum of a Bachelor’s degree in Nursing must obtain a Bachelor’s degree in Nursing or higher within 3 years of hire, any previously agreed upon effective date for obtaining a Bachelor’s degree in nursing between individual and facility will remain in effect, or.
Adventist HealthNewRN - Lead Care Manager (Full-Time, Day Shift) Adventist HealthRN - Lead Care Manager (Full-Time, Day Shift)Bell Gardens, CAJob 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.
TravelNurseSourceNewTravel Nurse RN - Case Manager - $2,400 to $2,600 per week in Santa Monica, CA TravelNurseSourceTravel Nurse RN - Case Manager - $2,400 to $2,600 per week in Santa Monica, CASanta Monica, CA$2,400–$2,600The RN Case Manager will be responsible for coordinating patient care, performing admission reviews, and managing discharge planning while ensuring efficient utilization of healthcare resources. Job Overview We are seeking an experienced Registered Nurse – Case Manager to join an acute care hospital’s Case Management team.
TravelNurseSourceNewTravel Nurse RN - Case Manager - $2,423 per week in Paramount, CA TravelNurseSourceTravel Nurse RN - Case Manager - $2,423 per week in Paramount, CAParamount, CA$2,423–$2,423Enhances the quality of patient management and satisfaction to promote continuity of care and cost-effectiveness through integrated case management functions. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation, and overall evaluation of individual patient needs.
TravelNurseSourceNewTravel Nurse RN - Case Manager - $2,800 to $3,000 per week in Los Alamitos, CA TravelNurseSourceTravel Nurse RN - Case Manager - $2,800 to $3,000 per week in Los Alamitos, CALos Alamitos, CA$2,800–$3,000Job Summary:The RN Case Manager is responsible for managing inpatient case management activities including utilization review, discharge planning, and ensuring regulatory compliance. The role focuses on coordinating patient care, optimizing healthcare resources, and supporting safe and timely patient discharges.
TravelNurseSourceNewTravel Nurse RN - Case Manager - $2,450 to $2,650 per week in Torrance, CA TravelNurseSourceTravel Nurse RN - Case Manager - $2,450 to $2,650 per week in Torrance, CATorrance, CA$2,450–$2,650Interdisciplinary Support: Physical Therapy, Respiratory Services, Radiology, Social Services, Pharmacy, Rapid Response Team, Transportation, and other clinical support teams. The RN Case Manager will be responsible for coordinating patient care, conducting utilization review, and managing discharge planning while ensuring appropriate use of healthcare resources.
One MedicalNewVirtual Family Nurse Practitioner - CA Licensed One MedicalVirtual Family Nurse Practitioner - CA LicensedLos Angeles, CA$59.10–$65.50 / hourIn the past 5 years, practiced as an Advanced Practitioner for at least: 2 years in an outpatient primary care setting seeing patients of all ages (0+), OR 2 years in an urgent care or emergency medicine setting seeing patients of all ages (0+) . The One Medical Virtual Medical Team (VMT) is a leading provider of virtual clinical care, providing world-class, convenient, evidence-based virtual medical care to One Medical patients in concert with their primary care providers.
TravelNurseSourceNewTravel Nurse RN - Case Manager - $2,600 to $2,850 per week in Santa Monica, CA TravelNurseSourceTravel Nurse RN - Case Manager - $2,600 to $2,850 per week in Santa Monica, CASanta Monica, CA$2,600–$2,850Travel Perks: Explore Santa Monica, CA Enjoy life on the California coast while working in Santa Monica: stroll the iconic Santa Monica Pier and beach, shop and dine along Third Street Promenade, bike the beachfront path to Venice, hike scenic trails in the Santa Monica Mountains, catch sunsets at Palisades Park, and take quick trips into Los Angeles for museums, concerts and theater. Hashtags #CaseManagerJobs #AcuteCareCaseManager #SantaMonicaCAJobs #HealthcareJobs #UHCCareers #EpicJobs #InterQual #CareCoordination #DischargePlanning #TravelHealthcare.
TravelNurseSourceNewTravel Nurse RN - Case Manager - $2,600 to $2,850 per week in Torrance, CA TravelNurseSourceTravel Nurse RN - Case Manager - $2,600 to $2,850 per week in Torrance, CATorrance, CA$2,600–$2,850Travel Perks: Explore Torrance, CA Torrance sits in the beautiful South Bay — you can spend downtime strolling Torrance Beach or exploring Redondo and Manhattan Beach piers, shop at Del Amo Fashion Center, enjoy nature at Madrona Marsh, or take quick weekend trips to the Palos Verdes cliffs and Long Beach (Aquarium of the Pacific). Hashtags #AcuteCareCaseManagerJobs #TorranceCAJobs #HealthcareJobs #CaseManagement #InterQual #EpicJobs #UHCCareers #CareCoordination #TravelHealthcare #DischargePlanning.
JobotNewPsychiatrist JobotPsychiatristLos Angeles, CA$220,000–$260,000 / yearKey services include housing, mental health care, medical care, domestic violence services, substance abuse treatment, income assistance and life skills programs --- all aimed at improving the self-sufficiency of the individuals and families served. Evaluates clients by interviewing client, family, and other persons; conducting physical examinations; observing behaviors; reviewing medical history and related documents; selecting, administering, and interpreting psychological tests; and ordering laboratory tests and evaluating results.
TravelNurseSourceNewTravel Nurse RN - Case Manager - $2,600 to $2,750 per week in Tarzana, CA TravelNurseSourceTravel Nurse RN - Case Manager - $2,600 to $2,750 per week in Tarzana, CATarzana, CA$2,600–$2,750TravelNurseSource is working with Compunnel Healthcare to find a qualified Case Manager RN in Tarzana, California, 91356! 2-year acute medical Care Manager experience performing both roles of Care Coordination and Utilization Review.
Adventist HealthRN, Nurse Lead - ICU, Full-Time, Day Shift Adventist HealthRN, Nurse Lead - ICU, Full-Time, Day ShiftLos Angeles, CAAssigns staff to particular patients and patient care activities according to independent professional and supervisory analysis/assessment of the most effective utilization of skills and abilities, patient needs, and to equalize work loads of assigned personnel. Ensures compliance with Patient Safety Goals as identified by The Joint Commission, hospital policy, Quality Measures, and Patient Safety initiatives through unit management and participation in hospital Performance Improvement (PI) Teams.
SHARP HEALTHCARESRS -RN -Oncology Frost Street - Full Time - Day Shift SHARP HEALTHCARESRS -RN -Oncology Frost Street - Full Time - Day ShiftOrange, CA$80,000–$96,000 / 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. See Sharp HealthCare Terms & Conditions at https://www.sharp.com/patient-rights-privacy/terms-of-use.cfm and Privacy Policy at https://www.sharp.com/patient-rights-privacy/privacy-practices.cfm and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.
OptumNewBehavioral Health Care Advocate - Crisis Line - Remote - CA OptumBehavioral Health Care Advocate - Crisis Line - Remote - CAMontebello, CARemote$60,200–$107,400 / year2+ years of post graduate degree providing direct clinical services: psychosocial assessments, individual therapy, substance use drug/alcohol treatment, case consultation with multidisciplinary team; case management; developing treatment plans with short/long-term goals; maintain confidential files; in-service trainings and discharge planning. Master's level cleared behavioral health, California License: Licensed Marriage and Family Therapist (LMF), Licensed Clinical Social Worker (LCSW), Registered Nurse (RN), Licensed Professional Counselor (LPC) or Licensed Psychologist for position for the County of San Diego's 24/7 Access and Crisis Line (ACL).
Alignment Healthcare IncUtilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License) Alignment Healthcare IncUtilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)CARemote$85,696–$128,543 / yearServes as first-line SME/resource for inpatient UM questions Provides 1:1 coaching/shadowing support when needed Available and approachable/supportive while still helping to maintain accountability Provides guidance to staff or directly manages complicated requests from members, providers, or staff. 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.
Presidential Staffing Solutions, LLCUtilization Management Nurse Presidential Staffing Solutions, LLCUtilization Management NurseLos Angeles, CAFor 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.
UCLA Health SystemUtilization Management Nurse UCLA Health SystemUtilization Management NurseLos Angeles, CA$74.16–$107.75 / hourb'nn n n n n n n n n n n n nn n n n n n n n n n n n n n n n n n Utilization Management Nurse - - 30401 - UCLA Healthn n nnnn nn n n n nn nn n n Skip to content nnnnn nn UCLA Health Home Pagen nnn nnnn nnn Main menu. Press enter or space keys to expands and escape key to collapsennn nnn n n Search jobs n n nnn n n Employee Res...
NeueHealthNewUtilization Management Nurse, LVN/LPN NeueHealthUtilization Management Nurse, LVN/LPNLos Angeles, CA$26.35–$39.53 / hourBy 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.
NeueHealthNewUtilization Management Nurse, LVN/LPN (Work from Home) NeueHealthUtilization Management Nurse, LVN/LPN (Work from Home)Los Angeles, CA$27.10–$40.65 / hourBy 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.
Blue Cross and Blue Shield AssociationManager, Utilization Management Nurse Management Blue Cross and Blue Shield AssociationManager, Utilization Management Nurse ManagementWoodland Hills, CAThe Utilization Management team reviews inpatient stays and prior authorization for our members and correctly applies the guidelines for nationally recognized levels of care for both our Medi-Cal and Medicare populations. Demonstrated experience with basic management approaches such as work scheduling, prioritizing, coaching, process execution, work organization, inventory management, risk management and delegation.
UCLA Health SystemUtilization Management Manager, Medicare Advantage - RN UCLA Health SystemUtilization Management Manager, Medicare Advantage - RNlos angeles, CA$112,900–$256,900 / 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. 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.
Clever Care Health Plan IncUtilization Management Nurse I, RN Clever Care Health Plan IncUtilization Management Nurse I, RNHuntington Beach, CARemote$34.98–$42.85 / hourAt Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Blue Cross and Blue Shield AssociationNewUtilization Management Nurse, Senior Blue Cross and Blue Shield AssociationUtilization Management Nurse, SeniorWoodland Hills, CAIn this role you will be supporting the department by supporting the clinicians who perform first level determination approvals for members using BSC evidenced based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Commercial, Medi-Cal or Medicare. Ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity and determine post-acute needs of member including levels of care, durable medical equipment, and post service needs to ensure quality and cost-appropriate DC planning.
Macpower Digital Assets Edge Private LimitedUtilization Management Policy Initiatives Registered Nurse Macpower Digital Assets Edge Private LimitedUtilization Management Policy Initiatives Registered NurseLos Angeles, CA$102,183–$132,838 / yearThis 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.
NeueHealth IncUtilization Management Nurse, LVN/LPN NeueHealth IncUtilization Management Nurse, LVN/LPNCalifornia, CA$26.35–$39.53 / hourBy 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. Job Summary: The Concurrent Utilization Review (UR) Nurse is responsible for conducting real-time clinical reviews to ensure the medical necessity and appropriateness of healthcare services provided to members under a managed care health plan.
Welbe Health LLCNewUtilization Management RN Welbe Health LLCUtilization Management RNLos Angeles, CA$99,309.58–$131,088.64 / yearOur Health Plan Services team plays a critical role in our participant's journey and our Utilization Management team ensures we can provide timely, quality, compliant, and cost-effective care to our participants. At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, functioning as both a care provider and care plan to those individuals we serve.
Alignment Healthcare IncUtilization Management (UM) - Pre-Service (Remote | California RN / LVN | Pacific Time Schedule) Alignment Healthcare IncUtilization Management (UM) - Pre-Service (Remote | California RN / LVN | Pacific Time Schedule)CARemote$77,905–$116,858 / yearThis is a fast-paced, production-driven role ideal for nurses with recent pre-service UM experience in a managed care setting who are comfortable managing multiple cases, meeting turnaround time expectations, and collaborating cross-functionally in a fully remote environment. Reasoning Skills: Able 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.
CVS Health CorpNewUtilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantWork At Home, CA$29.10–$62.32 / hourUtilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
NeueHealthNewUtilization Management Nurse - RN NeueHealthUtilization Management Nurse - RNLos Angeles, CA$74,260.46–$111,390.70 / yearBy 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. o Evaluate and process prior authorization requests for medical procedures, medications, and services based on clinical guidelines such as: Medicare criteria, Medicaid/Medi-Cal criteria, InterQual, MCG, or Health Plan specific guidelines.
ForhyreTravel RN -Case Management Utilization Review ForhyreTravel RN -Case Management Utilization ReviewLos Angeles, Los Angeles County$1,900–$2,500 / weekThis 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.
Prime Healthcare Services IncDirector of Case Management Utilization Management Prime Healthcare Services IncDirector of Case Management Utilization ManagementInglewood, CA$108,160–$163,800 / yearAn award-winning facility, ranking in the top 5% nationally for quality and patient safety, Centinela Hospital is a 362-bed acute-care hospital with a 24-hour STEMI certified emergency department and primary stroke center, orthopedic care, advanced cardiac services, critical care services, inpatient and outpatient rehab programs, and more. Preferred leadership style and ideal candidate is a forward-thinking professional who thrives in a collaborative, fast-paced healthcare setting and is passionate about driving positive patient outcomes and reducing readmissions.
eTeam Inc.Utilization Review RN eTeam Inc.Utilization Review RNOrange, CACandidate 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) .
NeueHealthNewConcurrent Utilization Review Nurse, RN NeueHealthConcurrent Utilization Review Nurse, RNLos Angeles, CA$74,286.15–$111,429.23 / yearBy 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.
Los Angeles CountyUTILIZATION REVIEW NURSE SUPERVISOR II Los Angeles CountyUTILIZATION REVIEW NURSE SUPERVISOR IILos Angeles, CA$118,457.04–$177,314.88 / yearVeteran'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.
Centinela Hospital Medical CenterDirector of Case Management - Utilization Management Centinela Hospital Medical CenterDirector of Case Management - Utilization ManagementInglewood, California$108,160–$163,800 / yearAn award-winning facility, ranking in the top 5% nationally for quality and patient safety, Centinela Hospital is a 362-bed acute-care hospital with a 24-hour STEMI certified emergency department and primary stroke center, orthopedic care, advanced cardiac services, critical care services, inpatient and outpatient rehab programs, and more. Preferred leadership style and ideal candidate is a forward-thinking professional who thrives in a collaborative, fast-paced healthcare setting and is passionate about driving positive patient outcomes and reducing readmissions.
Providence St. Joseph HealthRN 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.
Providence St. Joseph HealthNewRN Utilization Review - Full-time - REMOTE Providence St. Joseph HealthRN Utilization Review - Full-time - 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.
St. Francis Medical CenterRN Case Manager - Utilization Review St. Francis Medical CenterRN Case Manager - Utilization ReviewLynwood, California$47.20–$63.45 / hourThe 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.
APN Consulting IncRegistered Nurse/Utilization Review APN Consulting IncRegistered Nurse/Utilization ReviewWhittier, CAThe 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.
Providence Health & ServicesUtilization Review RN Providence Health & ServicesUtilization Review RNMission Hills, CA$57.28–$88.92 / hourTogether, 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.
Providence St. Joseph HealthUtilization Review RN Providence St. Joseph HealthUtilization Review RNMission 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. 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.
NOR Healthcare SystemsRN Nurse Utilization Review - Full Time, Days (Los Angeles) NOR Healthcare SystemsRN Nurse Utilization Review - Full Time, Days (Los Angeles)Bellflower, CAThe 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.