- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Services As Needed / ... + FTE:0.01 + Posted:April 28, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations of the… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically… more
- Stanford Health Care (Palo Alto, CA)
- …practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, ... years of experience as an RN - 3+ years of experience in case management / utilization review Why work at Stanford Medicine | Stanford Health Care (SHC)? -… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …of physicians and nurses working with the Rady Children's Health Network. The Utilization Management Medical Director will collaborate closely with the clinical ... quality. The ideal candidate will have a strong pediatric clinical background. Utilization management experience is a plus. This position is part time with full… more
- CVS Health (Sacramento, CA)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in pacific time zones… more
- Evolent (Sacramento, CA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- ManpowerGroup (Rancho Cucamonga, CA)
- Our client, a leading healthcare organization, is seeking a Coordinator - Utilization Management Outpatient to join their team. As a Coordinator - Utilization ... Management Outpatient, you will be part of the Utilization Management Department supporting the healthcare team. The ideal candidate will have strong… more
- Prime Healthcare (Inglewood, CA)
- …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patiens ... education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200257/director-of-case- management utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityCentinela… more
- CVS Health (Sacramento, CA)
- …years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. + ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical Utilization Management (UM) provides comprehensive ... field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan + An active CA Registered Nurse… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team of UM ... of Science, Nursing (BSN) degree required + Five or more years of utilization management required + Four or more years of managerial experience required + Four… more
- Prime Healthcare (Chino, CA)
- …EDUCATION, EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/205766/discharge-planner utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityChino Valley Medical Center… more
- Humana (Sacramento, CA)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time ... + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards… more
- Elevance Health (Garden Grove, CA)
- ** Utilization Management Representative I** **Location:** Virtual in PST Zone **Hours:** Monday - Friday, 8:35 am - 5:05 pm PST. The ** Utilization ... Management Representative I** is responsible for coordinating cases for precertification and prior authorization review. **How will you make an impact:** + Managing incoming calls or inbound authorization requests received via fax. + Determines contract and… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review/ utilization management experience in an HMO, MSO, IPA, or health ... plan environment + Previous clinical experience + Experience drafting and issuing compliant adverse organization determinations + In-depth knowledge of health plan, DMHC, CMS, HIPPA, and NCQA requirements + Expertise in abstracting and interpreting medical… more
- Prime Healthcare (National City, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/205657/case-manager utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- Prime Healthcare (Redding, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/205446/social-worker-ii utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... related to treatment services, illness, disability or trauma. To provide case management & milieu management , complete psychosocial assessments, assist in the… more
- Dignity Health (Rancho Cordova, CA)
- …to collaborate with members of NSSA Regional Health Services Research (HSR), Utilization Management , Quality Management and various other departments, ... in the production of indicators and reports which incorporate measures of resource consumption (costs), clinical efficacy, and health and service outcomes. **Qualifications** **Required:** + 3 years analytical experience using analytical tools, computers, and… more