Utilization review nurse Jobs in San Jose, CA

Last updated: 10 hours ago

Promoted

Remote LVN Utilization Review Nurse

VirtualVocationsSunnyvale, California, United States

Remote

Full-time

Promoted

Continuing Care Utilization Review Coordinator RN

Kaiser PermanenteSanta Clara, CA, United States

$77,500.00–$100,265.00 yearly

Part-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: 8 days ago

Promoted

UTILIZATION MANAGEMENT NURSE, SENIOR

Blue Shield of CaliforniaCA, United States

Full-time

The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will repor...Show moreLast updated: 1 day ago

Utilization Management (UM) Nurse

ReqRouteSan Jose, CA, US

Remote

UM (Utilization Management) experience is REQUIRED.INTERQUAL experience is REQUIRED.Shift : PST hours (non-negotiable).Job Description and Requirements : . Ideal candidates will have a few years of Maj...Show moreLast updated: 30+ 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

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

Manager, Utilization Management (part-time)

Santa Clara Family Health PlanSan Jose, CA, United States

$126,818.00–$196,568.00 yearly

Part-time

Manager, Utilization Management (part-time).The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.Director of Medical Managem...Show moreLast updated: 16 days ago

Promoted

Manager, Utilization Management (part-time)

Santa Clara County Health PlanSan Jose, CA, United States

$126,818.00–$196,568.00 yearly

Part-time

Promoted
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: 10 hours ago

Utilization Behavioral Health Professional

HumanaWork at Home, 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

CARE REVIEW CLINICIAN

CollaberaCA, United States

$40.00–$45.00 hourly

Full-time

Remote : Long Beach, California, US.Days Left : 15 days, 2 hours left.Communicate effectively with hospital nurses, attending physicians, hospital administrative staff, and medical directors.Review h...Show moreLast updated: 1 day 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

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

HealthEcareers - ClientSanta Clara, California, United States

Full-time

Promoted
New!

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: 20 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

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

LVN, Preservice Review Nurse - Remote

UnitedHealth GroupSan Jose, CA, US

$19.47–$38.08 hourly

Remote

For those who want to invent the future of health care, here's your opportunity.We're going beyond basic care to health programs integrated across the entire continuum of care.The Prior Authorizati...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

Remote LVN Utilization Review Nurse

VirtualVocationsSunnyvale, California, United States

11 days ago

Job type

Full-time

Remote

Job description

A company is looking for a Remote LVN Utilization Review Nurse.Key ResponsibilitiesConducts retrospective clinical reviews using InterQual guidelines for medical necessityFollows documented processes for the clinical appellate process and adheres to productivity and quality goalsPerforms follow-up on initial denials and ensures accurate diagnosis and procedure codingRequired Qualifications, Training, and EducationHigh School Diploma or equivalent requiredCompletion of an accredited RN or LVN program requiredMinimum of 3 years clinical practice experience required2 years of utilization management and / or case management experience requiredActive, unrestricted State Registered Nursing license or Licensed Vocational Nursing license in good standing required