• Corporate Director of Clinical

    Prime Healthcare (Ontario, CA)
    …Responsibilities The Corporate Director of Clinical Utilization Management ... + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management...with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA)… more
    Prime Healthcare (04/17/25)
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  • RN Utilization Management

    The Cigna Group (Sacramento, CA)
    …Other duties as required and related to this role. **Minimum requirements:** + Active unrestricted Registered Nurse ( RN ) license in state or territory of the ... to develop models and procedures, and monitor trends, within Nurse Case Management . RN and...Scope:** + Manages/Coordinates an active caseload of inpatient case management cases for Cigna. + Uses clinical more
    The Cigna Group (05/29/25)
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  • Supervisor, Utilization Management

    LA Care Health Plan (Los Angeles, CA)
    Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is...player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
    LA Care Health Plan (04/11/25)
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  • RN Supervisor UM Inpatient Clinical

    Dignity Health (Bakersfield, CA)
    …will require Admin on-call on weekends/holidays.** **Position Summary:** The Supervisor of Utilization Management Inpatient Clinical will oversee clinical ... UM staff, ensuring they effectively perform utilization management (UM) reviews for inpatient cases. This role works...required. - Graduate of an accredited school of nursing: Registered Nursing. - Clear and current CA RN more
    Dignity Health (05/21/25)
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  • Clinical Documentation Integrity Specialist

    UCLA Health (Los Angeles, CA)
    …self-directed individual with: * Bachelor's degree in health-related field, preferred * A Registered Nurse ( RN ) license or MD diploma (or equivalent) ... or equivalent of education and experience in case management , utilization management or prior clinical documentation review experience, required *… more
    UCLA Health (05/30/25)
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  • Payment Integrity Nurse Coder RN III

    LA Care Health Plan (Los Angeles, CA)
    …8 years of clinical experience and a minimum of 3 years in utilization management or clinical coding. Investigation and/or auditing experience. Skills ... of Microsoft Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted… more
    LA Care Health Plan (04/11/25)
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  • Case Manager (CM) - Registered Nurse

    Select Medical (Los Angeles, CA)
    …Cedars, UCLA and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Registered Nurse ( RN ) or Social Worker (LCSW) **Per Diem** **Pay Rate: ... in Social Work required or Current state licensure as a Registered Nurse required. + Previous experience in Case Management and Discharge Planning preferred.… more
    Select Medical (05/14/25)
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  • Dialysis Clinical Manager Registered

    Fresenius Medical Center (San Diego, CA)
    **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
    Fresenius Medical Center (05/08/25)
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  • Registered Nurse ( RN )…

    ERP International (San Diego, CA)
    **Overview** ERP International is seeking a full-time **Perioperative** ** Registered Nurse ( RN )** to support the **Operating Room (OR) at** **Naval Medical ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
    ERP International (04/23/25)
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  • Clinical Registered Nurse

    Sharecare (Sacramento, CA)
    …ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification ... the disease management program intervention guidelines. A Clinical Registered Nurse is supervised...or call campaigns. + Accepts warm transfer calls from non- RN colleagues for assessment and/or additional discussion with participant… more
    Sharecare (05/10/25)
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  • Registered Nurse - Disease…

    Matrix Providers (Fairfield, CA)
    Registered Nurse - Disease Management Location: Fairfield, CA, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... and fair, reliable schedules. Matrix Providers is hiring a Registered Nurse - Disease Management ...identification, adoption, implementation and utilization of standardized clinical practice guidelines and protocols for management more
    Matrix Providers (05/30/25)
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  • Registered Nurse RN Associate…

    Banner Health (Susanville, CA)
    …and clinical support to patients and staff. Uses depth and breadth of clinical management knowledge to ensure the provision of high quality, safe, and cost ... the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change...management as normally demonstrated through two years of clinical management experience relevant to patient population.… more
    Banner Health (03/20/25)
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  • Senior Registered Nurse - QAPI

    Ventura County (Ventura, CA)
    …TRAINING, and EXPERIENCE Requires two (2) years of experience as a full-time professional registered nurse in a clinical nursing patient care delivery ... They will collaborate with a multidisciplinary team to improve clinical outcomes, support quality management studies, and...two (2) years of experience as a full-time professional registered nurse in a clinical more
    Ventura County (05/19/25)
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  • Registered Nurse II - North County

    The County of Los Angeles (Los Angeles, CA)
    REGISTERED NURSE II - NORTH COUNTY Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/1164632) Apply  REGISTERED NURSE II - NORTH ... medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services...experience* at the level of Los Angeles County classification Registered Nurse I**. -AND- 2. A license… more
    The County of Los Angeles (03/30/25)
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  • Registered Nurse - Case Manager

    ERP International (Twentynine Palms, CA)
    **Overview** ERP International is seeking ** Registered Nurse ( RN ) Case Managers** for full-time positions in support of the **Naval Hospital Twentynine ... algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with… more
    ERP International (04/23/25)
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  • Registered Nurse - Case Manager

    ERP International (Port Hueneme, CA)
    …(CRRN),(COHN), (ACCC), (CRC), ( RN -NCM),(CMC) **OR** Possess a Master's Degree in Nurse Case Management from a program accredited by the American Nurses ... **Overview** ERP International, LLC is seeking a ** Registered Nurse - Case Manager** for...and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case… more
    ERP International (03/04/25)
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  • Registered Nurse Remote

    Actalent (Rancho Cordova, CA)
    Job Title: Registered NurseJob Description The Commercial Appeals and Grievance Registered Nurse ( RN ) reviews and processes appeals resulting from ... + 1 year of Utilization Review/ Management experience + Proficiency in Utilization Management and Utilization Review + Knowledge of MCG and prior… more
    Actalent (05/19/25)
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  • Case Manager, Registered Nurse

    Sutter Health (Auburn, CA)
    …+ Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** + ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN...resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical more
    Sutter Health (05/22/25)
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  • Case Manager II, Registered Nurse

    Sutter Health (Burlingame, CA)
    …: **EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire CCM certification ... acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the… more
    Sutter Health (05/07/25)
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  • Registered Nurse III - Cancer Center…

    Cedars-Sinai (Los Angeles, CA)
    …therapeutic modalities in an honest, encouraging, supportive and conscientious manner. As a Clinical Nurse III, you will deliver direct care to assigned adult ... passion for using your nursing skills in an innovative clinical environment? Samuel Oschin Center offers the most appropriate...continued employment. **Req ID** : 8846 **Working Title** : Registered Nurse III - Cancer Center Exams… more
    Cedars-Sinai (03/30/25)
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