NewTravel Nurse RN - Utilization Review - $2,557 to $2,652 per week in Oakland, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $2,557 to $2,652 per week in Oakland, CAOakland, CA$2,557–$2,652As 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 - $2,630 to $2,725 per week in Oakland, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $2,630 to $2,725 per week in Oakland, CAOakland, CA$2,630–$2,725As 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 - $2,233 per week in Oakland, CA TravelNurseSourceTravel Nurse RN - Utilization Review - $2,233 per week in Oakland, CAOakland, CA$2,233Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
NewTravel Nurse RN - Case Management - $3,041 per week Slate HealthcareTravel Nurse RN - Case Management - $3,041 per weekOakland, CASlate Healthcare is a premier travel healthcare staffing agency, connecting healthcare professionals with thousands of opportunities at top-tier hospitals and facilities across the country. At Slate, we empower our professionals to choose when and where they work, while ensuring they receive the highest compensation possible—because we believe that exceptional care starts with empowered caregivers.
NewTravel Case Manager RN - $3,171 per week American TravelerTravel Case Manager RN - $3,171 per weekOakland, CARTO is limited to 7 days per contract; only 1 holiday may be requested off per contract (eligible holidays: New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day). American Traveler is seeking an experienced RN Case Manager for an inpatient acute care hospital position requiring a CA RN license and a minimum of 5 years of RN Case Management experience.
NewTravel Case Manager RN - $3,251 per week Prime StaffingTravel Case Manager RN - $3,251 per weekOakland, CAModified Time:8/24/2026 12:00:00 AM Account Manager: Quinton Reed Account Manager Email: COVID-19 Vaccine: Unknown Flu Vaccine: Unknown Submittals:Med Job Requirements & Qualifications Previous Charge Experience: Preferred Years of Experience: 2 Patient Ratio Experience: 10 Charting System Experience: - Charting System Name: Epic Community Hospital Experience: - LTAC Experience: - Trauma Level I Experience: - Trauma Level II Experience: - Travel Experience Required: - Certifications: BLS, CA RN LicenseSkills: Acute Hospital, Care coordination, Discharge Planning Unit Details Staffing & Scheduling Scheduling Type: - Patient Ratios Days: 15 Patient Ratios Nights: - Patient Ratios Weekends: 25 Float Required: - Call Required: - Weekend Coverage: True Number of Weekend Shifts Per Contract: - Pre-Approved Time Off: - Orientation Hours: - Facility & Patient Care Details Patient Age Groups: Adults, Geriatrics Daily Census: - Number of Visits Per Day: - Number of Rooms: - Number of Beds: - Additional Unit Information Interdisciplinary Support: - Patient Diagnoses: - Special Procedures/Unit Details: - Special Equipment: - #Tier3 Travel Compliance Sutter Submission Rules: Local candidates: Locals accepted at local rate; 50-mile radius rule RN Licensure: Uploaded Nursys within the last 2 weeks with Valid CA State License Certifications: Uploaded any applicable certifications with valid expiration dates Certifications must be AHA or ARC References: 2 references obtained within the last year Return Staff/Travelers: No separation time required. Any time spent on modules exceeding the 16 NBO hours are billable Modules are completed during orientation, and module hours vary by specialty Modules are recorded through e-learning Submittal Details: #Tier3 Travel ComplianceSutter Submission Rules:Local candidates: Locals accepted at local rate; 50-mile radius ruleRN Licensure: Uploaded Nursys within the last 2 weeks with Valid CA State LicenseCertifications: Uploaded any applicable certifications with valid expiration datesCertifications must be AHA or ARCReferences: 2 references obtained within the last yearReturn Staff/Travelers: No separation time required.
NewTravel RN Case Manager - $3,251 per week Prime StaffingTravel RN Case Manager - $3,251 per weekOakland, CAModified Time:8/24/2026 12:00:00 AM Account Manager: Quinton Reed Account Manager Email: COVID-19 Vaccine: Unknown Flu Vaccine: Unknown Submittals:High Job Requirements & Qualifications Previous Charge Experience: Preferred Years of Experience: 2 Patient Ratio Experience: 10 Charting System Experience: Preferred Charting System Name: Epic Community Hospital Experience: Preferred LTAC Experience: Preferred Trauma Level I Experience: - Trauma Level II Experience: - Travel Experience Required: Yes Certifications: BLS*Skills: Acute Hospital, Admission Criteria*, Admission Criteria*, Appeals and Denials*, Appeals and Denials*, Care coordination, CMS: Centers for Medicare and Medicaid Services*, Concurrent Review*, Concurrent Review*, Continued Stay Reviews*, Continued Stay Reviews*, Disability case management*, Discharge Planning, DRG (Diagnosis Related Groups)*, Emergency Department*, Home Health*, Hospice*, ICU*, MS*, Needs Assessment/ Order DME*, Prior Authorizations*, SDU/PCU/IMC/Obs*, Utilize InterQual Criteria*, Utilize InterQual Criteria*, Utilize Milliman Guidelines*, Utilize Milliman Guidelines*, screen any missing skills, Please note ratio Unit Details Staffing & Scheduling Scheduling Type: Other Patient Ratios Days: -25 Patient Ratios Nights: - Patient Ratios Weekends: -25 Float Required: - Call Required: no Weekend Coverage: True Number of Weekend Shifts Per Contract: - Pre-Approved Time Off: one Orientation Hours: - Facility & Patient Care Details Patient Age Groups: Adults, Geriatrics Daily Census: - Number of Visits Per Day: - Number of Rooms: - Number of Beds: - Additional Unit Information Interdisciplinary Support: - Patient Diagnoses: - Special Procedures/Unit Details: Patient ratio is 1:21 and could sometime be 1:25 but they do their best to keep it between 1:12 / 1:15 Special Equipment: - #Tier3 Travel Compliance Sutter Submission Rules: Local candidates: Locals accepted at local rate; 50-mile radius rule RN Licensure: Uploaded Nursys within the last 2 weeks with Valid CA State License Certifications: Uploaded any applicable certifications with valid expiration dates Certifications must be AHA or ARC References: 2 references obtained within the last year Return Staff/Travelers: No separation time required. Any time spent on modules exceeding the 16 NBO hours are billable Modules are completed during orientation, and module hours vary by specialty Modules are recorded through e-learning Submittal Details: #Tier3 Travel ComplianceSutter Submission Rules:Local candidates: Locals accepted at local rate; 50-mile radius ruleRN Licensure: Uploaded Nursys within the last 2 weeks with Valid CA State LicenseCertifications: Uploaded any applicable certifications with valid expiration datesCertifications must be AHA or ARCReferences: 2 references obtained within the last yearReturn Staff/Travelers: No separation time required.
Chief CRNA (Certified Registered Nurse Anesthetist) Kaiser PermanenteChief CRNA (Certified Registered Nurse Anesthetist)Oakland, CA$268,500Coordinates patient care delivery among departments such as pain service, pharmacy, laboratory, Labor & Delivery and perioperative care, etc, where anesthesia services are delivered or ancillary support is required. Develops and monitors operational budget for payroll and non- payroll expenses, capital planning and resources in collaboration with the Chief of Anesthesia and leadership.
Virtual Family Nurse Practitioner - [Overnights - CA / NY / DC licensed] One MedicalVirtual Family Nurse Practitioner - [Overnights - CA / NY / DC licensed]San Francisco, CA$73.70–$81.90 / hourIn the past 5 years, practiced as an FNP: 4 years in an outpatient primary care setting seeing patients of all ages (0+), OR 4 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.
Virtual Family Nurse Practitioner - CA Licensed One MedicalVirtual Family Nurse Practitioner - CA LicensedSan Francisco, 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.
NewTravel Nurse RN - Case Manager - $3,056 per week in Oakland, CA TravelNurseSourceTravel Nurse RN - Case Manager - $3,056 per week in Oakland, CAOakland, CA$3,055.60Modified 12:00:00 AM Account Manager: Quinton Reed Account Manager Email: COVID-19 Vaccine: Unknown Flu Vaccine: Unknown Job Requirements & Qualifications Previous Charge Experience: Preferred Years of Experience: 2 Patient Ratio Experience: 10 Charting System Experience: Preferred Charting System Name: Epic Community Hospital Experience: Preferred LTAC Experience: Preferred Trauma Level I Experience: - Trauma Level II Experience: - Travel Experience Required: Yes Certifications: BLS*Skills: Acute Hospital, Admission Criteria*, Admission Criteria*, Appeals and Denials*, Appeals and Denials*, Care coordination, CMS: Centers for Medicare and Medicaid Services*, Concurrent Review*, Concurrent Review*, Continued Stay Reviews*, Continued Stay Reviews*, Disability case management*, Discharge Planning, DRG (Diagnosis Related Groups)*, Emergency Department*, Home Health*, Hospice*, ICU*, MS*, Needs Assessment/ Order DME*, Prior Authorizations*, SDU/PCU/IMC/Obs*, Utilize InterQual Criteria*, Utilize InterQual Criteria*, Utilize Milliman Guidelines*, Utilize Milliman Guidelines*, screen any missing skills, Please note ratio Unit Details Staffing & Scheduling Scheduling Type: Other Patient Ratios Days: -25 Patient Ratios Nights: - Patient Ratios Weekends: -25 Float Required: - Call Required: no Weekend Coverage: True Number of Weekend Shifts Per Contract: - Pre-Approved Time Off: one Orientation Hours: - Facility & Patient Care Details Patient Age Groups: Adults, Geriatrics Daily Census: - Number of Visits Per Day: - Number of Rooms: - Number of Beds: - Additional Unit Information Interdisciplinary Support: - Patient Diagnoses: - Special Procedures/Unit Details: Patient ratio is 1:21 and could sometime be 1:25 but they do their best to keep it between 1:12 / 1:15 Special Equipment: - #Tier3 Travel Compliance Sutter Submission Rules: Local candidates: Locals accepted at local rate; 50-mile radius rule RN Licensure: Uploaded Nursys within the last 2 weeks with Valid CA State License Certifications: Uploaded any applicable certifications with valid expiration dates Certifications must be AHA or ARC References: 2 references obtained within the last year Return Staff/Travelers: No separation time required. Any time spent on modules exceeding the 16 NBO hours are billable Modules are completed during orientation, and module hours vary by specialty Modules are recorded through e-learning Submittal Details: #Tier3 Travel ComplianceSutter Submission candidates: Locals accepted at local rate; 50-mile radius ruleRN Licensure: Uploaded Nursys within the last 2 weeks with Valid CA State LicenseCertifications: Uploaded any applicable certifications with valid expiration datesCertifications must be AHA or ARCReferences: 2 references obtained within the last yearReturn Staff/Travelers: No separation time required.
NewTravel Nurse RN - Case Manager - $3,079 per week in Oakland, CA TravelNurseSourceTravel Nurse RN - Case Manager - $3,079 per week in Oakland, CAOakland, CA$3,079Job Title: Case Manager RN Profession: Registered Nurse Specialty: Case Manager Duration: 13 Shift: Day 5x8-Hour Hours per Shift: 8 Experience: 5+ Years of RN Case Management experience License: CA RN License Certifications: BLS Must-Have: Inpatient Acute Case Management experience Description: Case Manager RN needed for 5/8s every other weekend. Works in collaboration with the physician, utilization manager, medical social worker, and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions.
NewTravel Nurse RN - Case Manager - $2,267 per week in San Leandro, CA TravelNurseSourceTravel Nurse RN - Case Manager - $2,267 per week in San Leandro, CASan Leandro, CA$2,267Enhances the quality of patient management and satisfaction to promote continuity of care and cost-effectiveness through the integration of functions of case management, utilization review and management, and discharge planning. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation, and overall evaluation of individual patient needs.
Utilization Management RN - Case Management - Relief/Per Diem Stanford Health CareUtilization Management RN - Case Management - Relief/Per DiemPALO ALTO, CA$79.21–$104.97 / hourWorking in collaboration with Physician Advisors, Financial Services, Compliance, Denials Management, Patient Access, Clinical Documentation Integrity, Billing, and Revenue Cycle, the UM RN plays an essential role in the financial health of the institution, navigating the complexities of patient care and resource utilization management, and education. Primary responsibilities include: Coordination with Healthcare Teams: Work closely with other healthcare professionals, patients, and payers to assess, plan, coordinate, monitor, and evaluate the delivery of healthcare services and appropriate levels of care.
Utilization Management Nurse RN 5 Wollborg Michelson RecruitingUtilization Management Nurse RN 5Oakland, CAProvides referrals to Case Management, Disease Management, Appeals and Grievance, and Quality departments as needed. Supports post-service and prior authorization review processes and collaborates with clinical leadership to ensure appropriate care determinations.
Manager, Utilization Management Nurse Management Blue Cross and Blue Shield AssociationManager, Utilization Management Nurse ManagementOakland, 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.
Utilization Management Nurse, Senior- Medicare Concurrent Review Blue Cross and Blue Shield AssociationUtilization Management Nurse, Senior- Medicare Concurrent ReviewOakland, 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.
NewUtilization Management Registered Nurse (RN) Prior Authorization Impresiv HealthUtilization Management Registered Nurse (RN) Prior AuthorizationOakland, CARemoteAs part of a high-impact transformation initiative, you will strengthen clinical decision-making, improve referral appropriateness, and support better outcomes for members and provider partners. A minimum of five years of Utilization Management experience within a Medicare Advantage health plan, Independent Practice Association, Management Services Organization, delegated medical group, or managed care organization.
Utilization Management Nurse, Senior Blue Cross and Blue Shield AssociationUtilization Management Nurse, SeniorOakland, CAThe Utilization Management team independently manages complex utilization and retrospective clinical reviews across multiple lines of business, assessing medical necessity, coding accuracy, treatment plans, discharge planning, and compliance requirements while supporting clinical consistency, process improvement, quality, timeliness, and appropriate escalation of high-risk cases. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
NewNurse Manager - Utilization Management/Discharge Planning Macpower Digital Assets Edge Private LimitedNurse Manager - Utilization Management/Discharge PlanningSan Francisco, CA$166,000–$259,000 / yearKey Responsibilities: Leads best practice implementation and patient care delivery systems across multiple locations. Leads strategic projects for operational efficiency, quality improvement, and root cause analysis.
RN - Case Manager - AS Utilization Management - Part Time - 8 Hour - Days John Muir HealthRN - Case Manager - AS Utilization Management - Part Time - 8 Hour - DaysWalnut Creek, CA$89.23–$121.58 / hourThe inpatient case manager applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patients health care needs through hospitalization and transition back to the community and does this in coordination with the interdisciplinary health team. Strong know ledge of geriatrics and the impact to health and function in the aged as w ell as a working know ledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc.
RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days John Muir HealthRN - Case Manager - AS Utilization Management - Full Time - 8 Hour - DaysWalnut Creek, CA$89.23–$121.58 / hourThe inpatient case manager applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient's health care needs through hospitalization and transition back to the community and does this in coordination with the interdisciplinary health team. Strong know ledge of geriatrics and the impact to health and function in the aged as w ell as a working know ledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc.
RN - Case Manager - AS Utilization Management - Walnut Creek - Full Time - 8 Hour - Days John Muir HealthRN - Case Manager - AS Utilization Management - Walnut Creek - Full Time - 8 Hour - DaysWalnut Creek, CA$89.23–$121.58 / hourThe inpatient case manager applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient's health care needs through hospitalization and transition back to the community and does this in coordination with the interdisciplinary health team. Strong know ledge of geriatrics and the impact to health and function in the aged as w ell as a working know ledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc.
UTILIZATION MANAGEMENT COORDINATOR I MSO North East Medical ServiceUTILIZATION MANAGEMENT COORDINATOR I MSOBurlingame, CAThe Utilization Management Coordinator I functions under the direct supervision of a physician or Registered Nurse, performing utilization management (UM) and care coordination duties for the NEMS MSO. Responsible to prepare and present complex cases to Medical Director for review; confirm Medical Directors approval/modification/denial decision for record tracking.
Manager, Behavioral Health Utilization Management Blue Cross and Blue Shield AssociationManager, Behavioral Health Utilization ManagementOakland, CAThe Behavioral Health Utilization Management (UM) team performs prior authorization and concurrent reviews for members by applying evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
RN Manager - Care Management Veracity Software IncRN Manager - Care ManagementPetaluma, CAYes/No – details): Experience managing Care Management, Utilization Review, Discharge Planning, Care Coordination, or Transitional Care teams (Yes/No – details): Experience working with Social Determinants of Health, Complex Care Coordination, and Transitional Care Management (Yes/No – details): Experience with Quality Improvement, Performance Improvement, Productivity Metrics, and Departmental Reporting (Yes/No – details): Experience with staff recruitment, hiring, coaching, performance management, and retention (Yes/No – details): Motivation / Reason for Relocation (if not local): Motivation / Reason for interest in this position: Contact Number: Email ID: LinkedIn Profile URL: Full Address (Street, City, State, Zip Code): Current Location: Notice Period (in weeks): Current Work Authorization Status: Expected Salary: Are you willing to relocate at your own expense and work onsite in Petaluma, California? Full Name: Degree (BSN/MSN) – University & Completion Year: Current California RN License (License # & Status): Certified Case Manager (CCM) Certification (Yes/No – details): Accredited Case Manager (ACM) Certification (Yes/No – details): Do you have at least 5 years of healthcare experience?
Manager, Case Management Nurse Management- Population Health Management Blue Cross and Blue Shield AssociationManager, Case Management Nurse Management- Population Health ManagementOakland, CAThis position oversees the day-to-day operations of business units and execution of departmental goals and objectives, to promote the delivery of quality, cost-effective healthcare services based on medical necessity and contractual benefits across the continuum of care. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Nurse, Care Management Alameda Health System FoundationNurse, Care ManagementSan Leandro, CA$77.67–$113.98 / hourRequired Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS - Basic Life Support Certification issued by the American Heart Association; other advanced life support certifications may be required per unit/department specialty according to patient care policies; CPI -Crisis Prevention Intervention Training (required for all positions at John George Psychiatric Pavilion; and certain positions in the Emergency Department). Collaborates with Care Management teams (i.e. Care Transition team and CM teams at other facilities) for high risk patients for timely follow-up appointments and confirms prior to discharge that complex patients are appropriately linked to community services.
Utilization Review Tech III Sutter HealthUtilization Review Tech IIISan Mateo, CA$47.94–$57.52 / hourTotal compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Critical thinking skills necessary to provide utilization review/discharge planning services appropriate to patients with complex medical, emotional and social needs.
RN Manager - Care Management Bryant Staffing SolutionsRN Manager - Care ManagementPetaluma, CA$186,638–$294,611 / yearThis leadership role is responsible for overseeing care coordination activities, supporting interdisciplinary collaboration, and ensuring patients receive appropriate services across the continuum of care. The position works closely with patients, families, physicians, social workers, payers, community partners, and post-acute providers to ensure comprehensive and coordinated care delivery.
Remote-Manager, Case Management SNP (California RN License Required) Alignment Healthcare IncRemote-Manager, Case Management SNP (California RN License Required)CARemote$113,332–$169,999 / yearIn this fully remote leadership role, you will oversee a high-performing care management team dedicated to improving outcomes for members with complex and chronic healthcare needs. Monitors activities to support the timeliness of Health Risk Assessment (Initial and Reassessment) completion, Individualized Care Plan (ICP) development and Interdisciplinary Care Team (ICT) delivery for SNP members.
RN- Care Review Clinician- Utilization Review (Remote- CA License Req) Molina Healthcare IncRN- Care Review Clinician- Utilization Review (Remote- CA License Req)San Francisco, 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.
Director of Utilization Bayside MarinDirector of UtilizationSan Rafael, California$105,000–$130,000 / yearFull timeIf applicable, c urrent licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required , within the state where the facility provides services. You won’t find a more passionate, experienced and skilled group of professionals who work closely to ensure a personalized and empowering treatment experience for every client.
Director of Utilization Acadia Healthcare Co IncDirector of UtilizationSan Rafael, CA$105,000–$130,000 / yearLICENSES/DESIGNATIONS/CERTIFICATIONS: If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. You won't find a more passionate, experienced and skilled group of professionals who work closely to ensure a personalized and empowering treatment experience for every client.
RN Manager - Care Management Full-time Day Providence Health & ServicesRN Manager - Care Management Full-time DayPetaluma, CA$89.73–$141.64 / hourRequsition ID: 435224 Company: Providence Jobs Job Category: Care Management Job Function: Clinical Care Job Schedule: Full time Job Shift: Day Career Track: Leadership Department: 7821 CASE MANAGEMENT PV Address: CA Petaluma 400 N McDowell Blvd Work Location: Petaluma Valley Hospital Workplace Type: On-site Pay Range: $89.73 - $141.64 Our not-for-profit network also 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.
RN Manager - Care Management Full-time Day Providence St. Joseph HealthRN Manager - Care Management Full-time DayPetaluma, CAThe goals of Case Management include the achievement of optimal health, access to services, advocacy, appropriate utilization of resources and collaboration with post-acute care providers to ensure patient''s needs are met in the community. 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.
Care Management - Nurse, Senior Blue Cross and Blue Shield AssociationCare Management - Nurse, SeniorOakland, CAThe Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support quality outcomes aligned with benefit and contract requirements. You will collaborate with providers, medical directors, and interdisciplinary teams to coordinate care, support discharge planning, evaluate barriers to care, and ensure members receive appropriate referrals and continuity of treatment.
RN, House Supervisor | Per Diem | Variable Shift Adventist Health SystemRN, House Supervisor | Per Diem | Variable ShiftVallejo, CASupervises the quality and effectiveness of patient care delivered throughout the Hospital, using such methods as: direct observation, rounds, reviewing reports, checking documentation in the medical record, and exerting influence and giving direction to employees as needed. Assesses routine and non-routine conditions of patients through identification of symptoms and behavioral changes, reviewing histories of physiological/psychological, cultural and spiritual information, reviewing medical data such as medical history, physical exams, plan of care, etc.
Nurse Case Manager II- Head and Neck Kaiser PermanenteNurse Case Manager II- Head and NeckOakland, CADrives services related to the initial case assessment by: interviewing patients and their families to evaluate needs, goals, and current services independently; identifying and proposing process improvements for determining initial eligibility, benefits, and education for all admissions; analyzing and ensuring authorization data (e.g., authorization data regarding admitting/principle diagnoses, bed type(s), and disposition data for accuracy, after visit summary) and correcting and escalating inaccuracies; recommending and designing research plans that identify new and/or existing options to assure that quality, cost-efficient care is provided; and leveraging advanced knowledge to assess medical necessity for hospital admission and required level of care to inform physicians. Supports efforts to remain updated on current research, policies, and procedures by: researching, recommending, and attending pertinent seminars, workshops, and approved educational programs and workshops specific to professional needs; implementing systems, processes, and methods to maintain team knowledge of community resources; monitoring and/or reviewing operational team data and key metrics applied to own work; making suggestions for change or improvement as needed, and helping others to develop ideas as needed; and implementing policy updates to ensure that regulatory requirements are being met.
NewTravel: RN Case Manager Integrated Resources, IncTravel: RN Case ManagerSAN LEANDRO, CA$50–$55 / hourMust have mininum 2 years recent RN Case Management experience, with experience in a LTAC or STACH setting, ClientG, discharge planning across acute care settings, strong IDT collaboration. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management and discharge planning.
RN, House Supervisor | Part Time Regular | Night Shift | Nursing Administration Adventist Health SystemRN, House Supervisor | Part Time Regular | Night Shift | Nursing AdministrationVallejo, CASupervises the quality and effectiveness of patient care delivered throughout the Hospital, using such methods as: direct observation, rounds, reviewing reports, checking documentation in the medical record, and exerting influence and giving direction to employees as needed. Assesses routine and non-routine conditions of patients through identification of symptoms and behavioral changes, reviewing histories of physiological/psychological, cultural and spiritual information, reviewing medical data such as medical history, physical exams, plan of care, etc.
Appeals & Grievance RN Wollborg Michelson RecruitingAppeals & Grievance RNOakland, CAUtilize National Coverage Determination (NCD), Local Coverage Determination (LCD), Milliman Care Guidelines, and other nationally recognized clinical guidelines such as NCCN and ACOG. This role is responsible for concurrent review of medical records and documentation, determining appropriate outcomes, and ensuring members have quality access to provider care.
Clinical Quality Oversight Nurse Wollborg Michelson RecruitingClinical Quality Oversight NurseOakland, CAThe Clinical Quality Reviewer investigates and evaluates potential quality of care issues (PQIs) arising from member grievances and internal referrals. The reviewer conducts case reviews according to department protocols, coordinates appropriate levels of review, and executes follow-up actions.
NURSE CASE MANAGER I P North East Medical ServiceNURSE CASE MANAGER I PBurlingame, CANurse Case Managers act as consultant to the clinical team, service lines, and other departments regarding patient assessment and patient care, and participate in program development and quality improvement initiatives in their role, by applying guidelines and collaborating with multidisciplinary teams, Case Managers influence and direct the delivery and quality of patient care. Nurse Case Managers differ from other roles in professional nursing/health care practice in that they do not provide direct medical care to patients; rather, a Nurse Case Manager will be assigned to specific patients to ensure that the medical services and treatments are accomplished in the most financially and clinically efficient manner.
Nurse Supervisor Population Health UCSF Medical CenterNurse Supervisor Population HealthBrisbane, CAWill be part of the OPH leadership team and will collaborates closely with other OPH leaders including the Vice President Population Health, Chief Population Health Officer, Medical Directors, other Managers and Director and key internal UCSFH Health and external community partners. This NS provides operational clinical oversight for the following disciplines: Registered Nurses, Advance Nurse Specialists, other Nursing positions who work in the areas of Complex Care Management, Transitions, and other Care Coordination Programs for both Adults and Pediatrics.
Manager - Case Management Tenet Healthcare CorpManager - Case ManagementSan Ramon, CAMonitors to ensure case management staff document in the Tenet Case Management documentation system to communicating information through clear, complete and concise documentation (20% daily, essential) Care Coordination • Works with Nursing and hospital leadership to ensure Patient Care Conferences and Complex Case Review processes are in place to promote timely and appropriate throughput • Participates in daily bed management meeting to support timely and effective patient placement and transfer within the hospital • Monitors to ensures that patients have a plan of care that is clinically appropriate, consistent with patient preference & choice and available resources • Monitors to ensures consults, testing and procedures are sequenced to support clinical needs with timely and efficient care delivery • Ensures patient needs are communicated and that the healthcare team is mutually accountable to achieve the patient plan of care • Effectively collaborates with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical outcomes (20% daily, essential) Education • Provides education to physicians regarding medical necessity, complete and accurate documentation, and compliance with related regulatory requirements • Prepares and provides data to physicians and the hospital on utilization of resources • Provides education to case management staff, physicians and the healthcare team relevant to the o Effective progression of care, o Appropriate level of care, and o Safe and timely patient transition (10% daily, essential) Compliance • Ensures compliance with federal, state, and local regulations and accreditation requirements impacting case management scope of services • Ensures that the department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies • Operates within the RN scope of practice as defined by state licensing regulations • Implements and monitors compliance with Tenet Case Management practices (10% daily, essential)Qualifications Required: Bachelor degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW. (20% daily, essential) Transition Management • Implements and monitors process to ensure that a transition plan assessment is completed within 24 hours of patient admission to identify and document the anticipated transition plan for patients • Ensures case management staff use electronic referral request process for patient placements • Monitors to ensure that patient preference & choice is documented per CMS regulations and Tenet policy • Identifies and reports variances in appropriateness of medical care provided, over/under utilization of resources compared to evidence-based practice and external requirements.
NewDirector of Case Management Macpower Digital Assets Edge Private LimitedDirector of Case ManagementSan Ramon, CA$180,000–$230,000 / yearJob Summary: The individual in this position has overall responsibility for hospital utilization management, transition management and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all state and federal regulations related to case management services. Other: Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, critical thinking and problem-solving skills and computer literacy.
Behavioral Health Care Management Manager Included Health IncBehavioral Health Care Management ManagerCA$114,330–$164,640 / yearStarting base salary for the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. This role reports directly to the Clinical Director, Care & Case Management and Utilization Management and plays a critical role in building & advancing Included Health's behavioral health strategy, specialty care pathways, and integrated medical-behavioral health model.
Manager - Case Management San Ramon Regional Medical CenterManager - Case ManagementSan Ramon, CAThe individual in this position has overall responsibility for hospital utilization management, transition management and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all state and federal regulations related to case management services. • Monitors case management processes and staff productivity to ensure medical necessity reviews are completed timely and accurately, payer communications are sent and authorizations or denials documented and followed up, and that transition planning assessments are completed timely.(20% daily, essential).