Utilization review nurse Jobs in Fremont, CA

Last updated: 8 hours ago

Promoted

CARE REVIEW CLINICIAN

CollaberaCA, United States

$43.00–$45.00 hourly

Full-time

Remote : Los Angeles, California, US.Days Left : 16 days, 2 hours left.Healthcare of CA requires two Registered Nurse roles to assist the Plan with discharge planning. This is a remote role and an exc...Show moreLast updated: 1 day ago

Promoted

Clinical Review Coordinator

Soleo Health IncHayward, CA, US

Full-time

Home Infusion Specialty Pharmacy Operations.Join us in Simplifying Complex Care!.Affordable Medical, Dental, & Vision Insurance Plans. Company Paid Disability & Basic Life Insurance.HSA &...Show moreLast updated: 4 days ago

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eDiscovery Review Attorney

Cooley LLPPalo Alto, CA, US

$180,000.00 yearly

Full-time +2

Cooley is seeking an eDiscovery Review Attorney to join the Litigation & E-Discovery Services team.As part of the Litigation and E-Discovery Services (LEDS) group, the E-Discovery Review Attorney p...Show moreLast updated: 10 hours ago

Promoted

State Licensed Utilization Review Nurse

VirtualVocationsFremont, California, United States

Full-time

A company is looking for a PRN Utilization Review Nurse Reviewer.Key ResponsibilitiesConduct assessments of medical services to ensure appropriateness and medical necessityExamine patient records t...Show moreLast updated: 6 days ago

Promoted

Continuing Care Utilization Review Coordinator RN

HealthEcareers - ClientNewark, California, United States

Full-time

Conducts utilization review for in-house patients and / or those members at contracted facilities.Assists in the discharge planning process. Conducts utilization review for in-house patients and / or me...Show moreLast updated: 30+ days ago

Promoted

UTILIZATION MANAGEMENT NURSE SPECIALIST RN II

L.A. Care Health PlanCA, United States

$142,166.00 yearly

Full-time

Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operat...Show moreLast updated: 4 days ago

Promoted

CARE REVIEW CLINICIAN, INPATIENT REVIEW (RN)

Molina HealthcareCA, United States

Full-time

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, inc...Show moreLast updated: 1 day ago

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New!

LAUSD Constructability Review Specialist

Simplex Construction Management, Inc.Los Angeles County, CA, US

$182,000.00–$203,000.00 yearly

Full-time

We are currently looking for a Constructability Review Specialist (LAUSD CM-CRS-0325-15) for our contract with Los Angeles Unified School District. Authorization to work lawfully in the US with...Show moreLast updated: 8 hours ago

Utilization Behavioral Health Professional

HumanaRemote, California

Remote

Full-time

Humana”) offers competitive benefits that support whole-person well-being.Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while...Show moreLast updated: 30+ days ago

Promoted

UTILIZATION NURSE / CARE COORDINATION / PER DIEM / REMOTE

Children's Hospital Los AngelesCA, United States

$64.50 hourly

Full-time

NATIONAL LEADERS IN PEDIATRIC CARE.Ranked among the top 10 pediatric hospitals in the nation, Children's Hospital Los Angeles (CHLA) provides the best care for kids in California.Here world-class e...Show moreLast updated: 1 day ago

Promoted

Clinical Review Coordinator

Soleo HealthHayward, CA, United States

$60,000.00–$80,000.00 yearly

Full-time

Promoted

eDiscovery Review Attorney

CooleyPalo Alto, CA, United States

$180,000.00 yearly

Full-time +1

Nurse Medical Management II - Utilization Management

Elevance HealthCalifornia

$72,080.00–$129,744.00 yearly

Full-time

This is a virtual position, but candidates must reside within 50 miles of an Elevance Health Pulse Point.Nurse Medical Management II - Utilization Management. Ensures medically appropriate, high qua...Show moreLast updated: 30+ days ago

Promoted

CONTINUING CARE UTILIZATION REVIEW COORDINATOR RN

Kaiser PermanenteCA, United States

$74.51–$96.40 hourly

Full-time

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LICENSED VOCATIONAL NURSE, UTILIZATION MANAGEMENT

AltaMed Health Services CorporationCA, United States

$30.15–$37.69 hourly

Full-time

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed.At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrat...Show moreLast updated: 18 hours ago

Promoted

BILINGUAL (SPANISH) CARE MANAGEMENT REVIEW NURSE

Western Growers Family of CompaniesCA, United States

$91,303.00–$130,542.00 yearly

Full-time

Western Growers Assurance Trust (WGAT).WGAT is now the largest provider of health benefits for the agriculture industry.The sponsoring organization of WGAT is Western Growers Association, created i...Show moreLast updated: 1 day ago

Promoted

UTILIZATION REVIEW RN CASE MANAGER

UCI Health - Fountain ValleyCA, United States

Full-time

UTILIZATION REVIEW RN Case Manager.Job Title : Registered Nurse (RN).Hours, includes some weekend shifts.Guaranteed Hours : Not specified. Perform comprehensive utilization reviews.Coordinate patient ...Show moreLast updated: 1 day ago

Promoted

UTILIZATION MANAGEMENT NURSE, SENIOR

Blue Shield of CaliforniaCA, United States

Full-time

The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions / never eve...Show moreLast updated: 1 day ago

Temporary Concurrent Review Nurse

The AllianceRemote in California

$46.50–$48.50 hourly

Remote

The length of the assignment is always dependent on business need and dates may change.While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment...Show moreLast updated: 30+ days ago

Medical Director, Utilization Management

Devoted HealthCalifornia

Remote

Full-time

This position interacts with utilization management, clinical management, pharmacy, network management, data analytics, legal, finance as well as other health plan departments.As a Medical Director...Show moreLast updated: 30+ days ago

CARE REVIEW CLINICIAN

CollaberaCA, United States

1 day ago

Salary

$43.00–$45.00 hourly

Job type

Full-time

Job description

Description

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Job Description

Care Review Clinician

Remote : Los Angeles, California, US

Salary Range : 43.00 - 45.00 | Per Hour

Job Code : 358861

End Date : 2025-03-16

Days Left : 15 days, 2 hours left

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Position Details : Industry Healthcare

Job Title Care Review Clinician II

Work Location CA - Remote

Duration 3 months

Pay Range $43 - $45 / hr

Job Description :

Healthcare of CA requires two Registered Nurse roles to assist the Plan with discharge planning.

This is a remote role and an exception has been provided for the candidate to reside in CA and be a licensed RN in CA.

These RN's will be working daily with CA hospitals, SNF's, and other lower level of care entities to discharge CA Health Plan members safely to a lower level of care. Utilization of MCG criteria.

Must Have Skills :

Minimum 5 years of clinical experience as an acute care nurse in med-surg / tele, ICU or ER setting

Minimum of 2 years (can be part of the 5 years above) as a hospital based discharge planner for patient discharges to home, SNF, custodial care, LTAC and ARU and an in-depth understanding of what services are available in each of these settings

Strong understanding of Medi-Cal post-acute care benefits- what is and is not a benefit

Strong understanding of MCG inpatient criteria

Experience with reviewing and interpreting facility contracts relating to post-acute levels of care (ie. SNF contract language)

Must demonstrate a high level of accountability to the process of safely, effectively and efficiently transferring members that no longer meet acute care criteria to the most appropriate lower level of care

Must demonstrate a compassionate communication style with members and providers to create seamless transitions in a member's care

Day to Day Responsibilities :

Working with CA hospitals, Skilled Nursing, and other lower level of care settings to discharge Health Plan members safely to a lower level of care.

Required Years of Experience :

Minimum 5 years of clinical experience as an acute care nurse in med surg / tele, ICU or ER setting.

Minimum 3 years discharge experience.

Managed care experience.

Required Licensure / Education : CA licensed RN, Located in CA

Job Requirement

registered nurse

discharge planning

acute care

Medical surgical

managed care

Reach Out to a Recruiter

Recruiter

Phone

Srividhya M

[email protected]

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