• Children's Hospital Los Angeles (Los Angeles, CA)
    …of healthcare services provided to all admitted patients. Using a value-based approach the Utilization Review Nurse ensures that care is administered via ... Matters.** **Overview** **Purpose Statement/Position Summary:** The Utilization Nurse is responsible for utilization review...- BSN or higher degree in nursing preferred. - Registered Nurse licensure in the State of… more
    DirectEmployers Association (10/14/25)
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  • Providence Little Company of Mary Medical Center - San Pedro (San Pedro, CA)
    …Offering Nursing Profession RN Specialty Case Manager Job ID 33531206 Job Title Registered Nurse - Case Manager @ Providence Little Company of Mary Medical ... Date 12/08/2025 Duration 13 Week(s) Job Description Job Title: Case Manager Profession: Registered Nurse Specialty: Case Management Duration: 13 weeks Shift: Day… more
    Upward (08/12/25)
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  • Providence Little Company of Mary Medical Center San Pedro-… (San Pedro, CA)
    … License Certifications: BLS - AHA Must-Have: Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager ... of Mary Medical Center San Pedro- Case Management Job Type Travel Offering Nursing Profession RN Specialty Case Manager Job ID 33531148 Job Title RN - Case… more
    Upward (08/12/25)
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  • Utilization Review Nurse

    The County of Los Angeles (Los Angeles, CA)
    …Considerable ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience ... OPTION II: Two (2) years of experience as a registered nurse , of which one year must...the County of Los Angeles, a Utilization Review Nurse is an RN ...Los Angeles, a Utilization Review Nurse is an RN that has Case… more
    The County of Los Angeles (10/06/25)
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  • Utilization Review Nurse

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR...CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board ... II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply  UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 -… more
    The County of Los Angeles (09/27/25)
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  • 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 (09/06/25)
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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/222731/ utilization - review - rn more
    Prime Healthcare (10/14/25)
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  • Director of Case Management - Utilization

    Prime Healthcare (Inglewood, CA)
    …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... outcomes and reducing readmissions. #LI-CC2 Qualifications Required qualifications: 1. CA Registered Nurse 2. Bachelor's of Science in Nursing3. Grandfathered… more
    Prime Healthcare (08/26/25)
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  • UM Prior Authorization Review Nurse

    UCLA Health (Los Angeles, CA)
    Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established… more
    UCLA Health (10/03/25)
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  • Care Review Clinician ( RN )

    Molina Healthcare (Los Angeles, CA)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
    Molina Healthcare (08/24/25)
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  • Medical Claim Review LVN/LPN (CA LVN…

    Molina Healthcare (Long Beach, CA)
    …**Required Experience** Minimum three years clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required ... Licensed Vocational Nurse (LVN) license in good standing. **Preferred Education** Registered Nurse . Bachelor's Degree in Nursing or Health Related Field… more
    Molina Healthcare (09/17/25)
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  • Registered Nurse - Clinical…

    Cedars-Sinai (Los Angeles, CA)
    …care field preferred Foreign trained MDs will be considered License/Certifications: Registered Nurse , LVN, Occupational Therapist, Physical Therapist, Physician ... of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required...for Hiring. **Req ID** : 10457 **Working Title** : Registered Nurse - Clinical Documentation Specialist -… more
    Cedars-Sinai (09/18/25)
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  • Assistant Nursing Director, Administration

    The County of Los Angeles (Los Angeles, CA)
    …clinical nursing. LICENSE(S) AND CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board or Registered ... in a state other than California must provide their Registered Nurse License Number from that state...Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL… more
    The County of Los Angeles (07/19/25)
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  • RN Care Coordinator - Inpatient Specialty…

    Cedars-Sinai (Beverly Hills, CA)
    …for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to ... that fuels innovation. **A Little More About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient while hospitalized… more
    Cedars-Sinai (10/12/25)
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  • Manager, Healthcare Services ( RN

    Molina Healthcare (Los Angeles, CA)
    …and experience. * At least 1 year of health care management leadership experience. * Registered Nurse ( RN ). License must be active and unrestricted in state ... in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS),… more
    Molina Healthcare (09/25/25)
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  • Enhanced Care Management Clinical Specialist II

    LA Care Health Plan (Los Angeles, CA)
    …Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse ( RN ); current and unrestrited California License. ... Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required Training Physical Requirements Light… more
    LA Care Health Plan (10/14/25)
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  • Dialysis Clinical Manager Registered

    Fresenius Medical Center (Pasadena, CA)
    …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
    Fresenius Medical Center (10/01/25)
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  • Dialysis Clinical Manager Registered

    Fresenius Medical Center (Newport Beach, CA)
    …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
    Fresenius Medical Center (09/19/25)
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  • RN Care Coordinator

    Dignity Health (Los Angeles, CA)
    …90 days of hire. + 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 (10/04/25)
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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 ... **Job Summary and 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 (10/01/25)
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