Rn case manager • clovis ca
Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems.We are seeking experienced Utilisation Management and Case Management leaders — including ... Show more
We are VITAS Healthcare, the nation’s leading end-of-life care provider since 1978.Our hospice organization kickstarts careers in caring, promotes from within, and provides a nationally recognized ... Show more
Schedule: Monday - Friday 8:00am-5:00pm.Are you a Registered Nurse who thrives on providing compassionate, whole-person careand wants to be more than just a caregiver, but a true advocate, companio... Show more
NATP PROGRAM DIRECTOR JOB DESCRIPTION.Under the supervision of the administrator, the NATP Registered Nurse Program Director (RNPD) directly oversees the Nurse Assistant Training Program and Instru... Show more
Locations: Merced, Fresno, Clovis, Hanford, Visalia, Bakersfield.Pivot your clinical expertise into a rewarding, autonomous advocacy role.We are seeking an exceptional **Registered Nurse (RN)** to ... Show more
The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP).This position is accountable and responsible for the provision and co... Show more
Bristol Hospice Fresno, CA - Fresno, CA 93711.Hourly Position Type FT Hourly Job Shift Day.Schedule: Monday - Friday 8:00am-5:00pm.Are you a Registered Nurse who thrives on providing compassionate,... Show more
COME BUILD YOUR CAREER WITH VIBRA HEALTHCARE!.We are seeking a Case Management Assistant to join our team!.San Joaquin Valley Rehabilitation Hospital, located in Fresno, CA, is a 62 bed acute rehab... Show more
Field Case Manager (RN) – Full-Time, Permanent.Join a dynamic and growing Case Management company that empowers Registered Nurses with greater autonomy over their caseloads—while still offering the... Show more
Why You’ll Love Working With Us.We believe that when we take care of our team, they can provide the best care to our patients — that’s why we invest in your well-being, growth, and success: Your ha... Show more
Case Manager of Community Engagement.To provide case management services, counseling, intervention and implementation of Individuals' plans to assist in developing, maintaining, increasing and maxi... Show more
CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Fresno, CA.Work from home, and on the road.Monday – Frid... Show more
ABOUT US:Founded in 2022, ForzaCare is a purpose-driven organization that helps injured individuals recover faster and return to work safely through coordinated, clinically appropriate care.Our nam... Show more
Make a difference every day as an Amedisys RN clinical manager.Join Amedisys-one of the largest and most trusted home health and hospice companies in the U.Choice of PPO or HSA medical plans with f... Show more
This position is responsible for providing a safer hospital and clinic environment by mitigating or reducing risks for all individuals within the organization.The incumbent serves as a resource for... Show more
Recommend and assist access to medical, educational, social, vocational, housing, and more to support program goals.Initiate referrals to next level care, coordinate with physical health providers ... Show more
Consecutively recognized as a top employer by Forbes, and in 2025 by Newsweek.We're excited to offer a progressive sign-on incentive and comprehensive relocation package.Eligible for annual incenti... Show more
Fresno Regional Workforce Development Board (FRWDB).Joint Powers Authority between the City and County of Fresno, with a business led model to help local organizations meet their workforce needs.We... Show more
RN Registered Nurse Supervisor.We are seeking to hire a self-motivated, efficient, responsible .Medical–Skilled Nursing Industry with many growth opportunities.This is a direct hir... Show more
Responsibilities of the Registered Nurse include but are not limited to:.Ensures proper resident care is maintained in a clean and safe environment.Develop and ensure the nursing care plan and coll... Show more
The average salary range is between $ 84,458 and $ 139,277 year , with the average salary hovering around $ 98,150 year .
The average salary range is between $ 66,272 and $ 111,200 year , with the average salary hovering around $ 78,000 year .
Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Utilisation Management and Case Management leaders — including RN UM directors, case management managers, and physician advisors — to evaluate AI tools designed to enhance clinical review, medical-necessity determination, and care-coordination workflows. Your clinical and operational expertise will directly shape AI systems that improve utilisation performance, reduce unnecessary care, and support value-based care objectives. **Responsibilities** - Lead utilisation management and/or case management operations, including concurrent review, retrospective review, discharge planning, and care coordination. - Evaluate AI-generated medical necessity determinations, clinical review outputs, and UM decision-support recommendations for accuracy and clinical appropriateness. - Conduct and oversee clinical reviews against InterQual, MCG, or Milliman care guidelines to support admission, continued stay, and level-of-care determinations. - Manage the physician advisor program to support complex UM cases, peer-to-peer review requests, and denial appeals. - Coordinate with clinical teams, payers, and post-acute providers to facilitate appropriate care transitions and discharge planning. - Monitor UM/CM KPIs, including avoidable days, denial rates, observation vs. inpatient conversion rates, and readmission rates. - Ensure compliance with CMS Conditions of Participation, Two-Midnight Rule, and payer-specific UM requirements. - Collaborate with revenue cycle, compliance, and clinical leadership to align UM performance with financial and quality objectives. - Annotate AI outputs and provide structured clinical feedback to support AI training datasets. **Requirements** - 5+ years of experience in utilisation management, case management, or clinical review, with at least 2 years in a leadership role. - Active clinical licensure (RN required; physician advisor/MD preferred) with strong medical necessity review expertise. - Deep knowledge of InterQual, MCG, or Milliman clinical review criteria. - Expertise in CMS Two-Midnight Rule, observation status regulations, and inpatient criteria. - Experience managing physician advisor programs and peer-to-peer review processes with payers. - Exceptional written and verbal English communication skills. - High attention to detail with the ability to critically evaluate clinical documentation and AI-generated UM outputs. **Preferred Qualifications** - CPUR (Certified Professional in Utilisation Review), ACM (Accredited Case Manager), or CCM (Certified Case Manager) credential. - MD or DO with UM/physician advisor experience preferred for physician advisor roles. - Experience with UM software platforms (Allscripts, Utilisation Management software, or equivalent). - Familiarity with AI tools and comfort evaluating AI-generated clinical review content. - Background in health system, ACO, or value-based care organisation UM programs. **Why Join?** - Contribute to the development of frontier AI systems in healthcare. - Collaborate with a world-class AI research organisation. - Gain exposure to cutting-edge AI workflows in utilisation management and clinical decision-support. - Opportunity to work on high-impact projects shaping the future of healthcare AI.
