• RN - Quality Assurance/ Utilization

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

    Prime Healthcare (Ontario, CA)
    …Post Graduate of an accredited school of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization Manager working for a ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Connect With Us! (https://careers-primehealthcare.icims.com/jobs/211752/ utilization - review - rn more
    Prime Healthcare (07/15/25)
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  • Case Manager, RN - Utilization

    Prime Healthcare (Lynwood, CA)
    …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/212260/case-manager%2c- rn utilization - ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April… more
    Prime Healthcare (06/24/25)
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  • Corporate Director of Clinical Utilization

    Prime Healthcare (Ontario, CA)
    …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with...with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA)… more
    Prime Healthcare (06/22/25)
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  • RN Care Coordinator

    Dignity Health (Long Beach, CA)
    …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... a sign-on bonus not to exceed 10% of salary for this position. The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning… more
    Dignity Health (07/06/25)
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  • RN Care Coordinator

    Dignity Health (Long Beach, CA)
    …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Responsibilities** The RN Care Coordinator is responsible for overseeing the...will be on care coordination communication and collaboration with utilization management nursing physicians ancillary departments insurers and post… more
    Dignity Health (07/02/25)
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  • Telephonic Nurse Case Manager

    ICW Group (Woodland Hills, CA)
    …Discharge Planning, or Home Health preferred. **CERTIFICATES, LICENSES, REGISTRATIONS** Current unrestricted Registered Nurse ( RN ) or Licensed Vocational ... regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and… more
    ICW Group (06/18/25)
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  • Case Manager ( RN ) - Utilization

    Prime Healthcare (San Dimas, CA)
    …experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… more
    Prime Healthcare (07/15/25)
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  • Case Manager ( RN ) - Utilization

    Prime Healthcare (Montclair, CA)
    …experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… more
    Prime Healthcare (07/15/25)
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  • Primary Care Physician (PCP)

    STG International (Corona, CA)
    …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. ... patient safety. *Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health… more
    STG International (06/18/25)
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  • Med Mgmt Nurse (US)

    Elevance Health (Costa Mesa, CA)
    …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... 5pm PST, this position includes weekends. The Med Mgmt Nurse is responsible for review of the...an equivalent background. + Current active, valid and unrestricted RN license and/or certification to practice as a health… more
    Elevance Health (07/10/25)
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  • Case Manager

    Pomona Valley Hospital Medical Center (Pomona, CA)
    …Associates degree. Three years acute hospital experience; one year experience in Utilization Review or Case Management; discharge planning and/or case ... of care. May perform other duties as assigned. Job Qualifications: [Required] Valid unrestricted California RN License. Graduate of accredited School of Nursing with… more
    Pomona Valley Hospital Medical Center (07/03/25)
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  • Strategic Clinical Quality Manager

    Fresenius Medical Center (Rancho Cucamonga, CA)
    …related field preferred or an equivalent combination of education and experience + Registered Nurse required + Certification in Nephrology Nursing or quality ... barriers to quality improvement. This includes promoting the adoption and utilization of Corporate Medical Advisory Board Recommended Algorithms and Standing Orders,… more
    Fresenius Medical Center (07/15/25)
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  • Nurse Reviewer I (US)

    Elevance Health (Costa Mesa, CA)
    ** Nurse Reviewer I** Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... to work weekends if necessary. New Grads are encouraged to apply! The ** Nurse Reviewer I** will be responsible for conducting preauthorization, out of network and… more
    Elevance Health (07/08/25)
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  • LCSW/LMFT - Orange County

    Amergis (Orange, CA)
    …help support a health insurance agency! The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for ... providers. The incumbent will be responsible for prior authorizations, concurrent review and related processes. Position Details: Location: Orange (Full Office, no… more
    Amergis (05/15/25)
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  • Behavioral Health Care Manager II

    Elevance Health (Cerritos, CA)
    …and outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** Primary duties may include, ... equivalent background. + Current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by...is licensed staff supervision. + Previous experience in case management/ utilization management with a broad range of experience with… more
    Elevance Health (07/12/25)
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