RN Utilization Review Case Manager — Optimize Care & Payer
Case Management Society of America (CMSA) ®
Case Management Society of America (CMSA) ® is seeking a Utilization Review Case Manager in Los Angeles, California. The role involves validating patient placements, ensuring appropriate levels of care using criteria such as InterQual or MCG, and collaborating with payers for authorizations. Candidates must possess a BSN and an unrestricted California RN License, with a minimum of 5 years in acute care nursing and 2 years in case management. Preference is given to those with an MSN and experience in emergency department case management. #J-18808-Ljbffr Case Management Society of America (CMSA) ®
- Case Management Society of America (CMSA) ® seeks a dedicated Utilization Review Case Manager in Los Angeles, California. In... ...appropriate level of care, using established... ...a current California RN License. This position... ...communication skills with payers. #J-18808-Ljbffr Case...Suggested
- ...be doing in this role? The Utilization Review Case Manager validates the patient's placement... ...most appropriate level of care based on nationally... ...collaboration and communication with payers as required. The UR Case... ..., unrestricted California RN License required BLS from...SuggestedDaily paid
$47.2 - $63.45 per hour
...quality and compassionate medical care. St. Francis is recognized... ...for the quality and resource management of all patients that are... ...comprehensive admission and concurrent review of the medical record for the... ...Social Worker. However, RN Case Manager preferred.3. Five...SuggestedFull timePart timeWork experience placementLocal areaShift work- ...Essential Duties: The Utilization Management (UM) Registered Nurse -... ...post-discharge clinical reviews for Medicare Short Stay cases and assists with real-time... ...management of concurrent payer denials. This role... ...payer timelines. The UM RN collaborates with physicians...Suggested
$68.84 per hour
...Description: The RN Case Manager is responsible for performing... ...of acute care Inpatients for the purpose of performing utilization review, resource management... ...patient and family to optimize client outcomes. May... ...the health care team, payer, and other relevant health...SuggestedDaily paidLocal areaImmediate start$74.29k - $111.43k
..., coordinated care. By uniquely aligning... ...Concurrent Utilization Review (UR) Nurse is... ...under a managed care health plan... ...communication with payers, and ensuring... ...for complex cases, denials, and... ...identifying resource optimization opportunities.... ...Nurse (RN) with an active...Work at office- Neuehealth is seeking a Concurrent Utilization Review Nurse in Los Angeles, CA.... ...healthcare services under managed care health plans. Responsibility... ...communication with payers, and adhering to compliance... ...experience in utilization review or case management. #J-18808-Ljbffr...
$47.31 - $100 per hour
...team, provides care coordination services... ...team in the management of specific... ...populations. The RN case manager role... ...the functions of utilization management, quality... ...may impede optimal patient care. •... ...Completes clinical reviews timely and... ...to appropriate payer. • Able to prioritize...Hourly payDaily paidContract work- ...Hospice Registered Nurse Case Manager – Leadership Role... ...in Hospice Care! Are you an experienced Hospice RN who thrives in leadership... ...treatments, and optimal patient outcomes.... ...Oversight – Monitor and review patient care,... ...living conditions. Utilize a tablet or laptop...Local area
$139.3k - $160.09k
...Nurse Director of Case Management Utilization Review —ignite an impact-driven leadership... ...Review will champion care coordination excellence, operational... ...and management, payer collaboration, InterQual/MCG... ...application, length-of-stay optimization, discharge planning, and care...Full timeRelocation packageWeekend work$34 - $45 per hour
...Case Manager (LVN/RN) (On-Field - Inland Empire) Astrana Health... ...100% compliance with Utilization Management health... ...~ Utilize Milliman Care Guidelines criteria for... ...initial and concurrent reviews based on the review... ...healthcare stakeholders (payer, provider, and...Hourly payFull timeWork at office- Working Nurse is seeking a Case Manager - Care Coordinator for a full-time position... ...continuity, facilitating payer authorization processes, and... ...ensuring efficient resource utilization. Minimum education includes... ...background in Utilization Review and Discharge Planning,...Full timeDay shift
- ...Registered Nurse Case Manager Align yourself... ...highest-quality medical care in Los Angeles. We... ...of the patient. Reviews care and treatment... ...patients using utilization review tool. Provides... ...with third-party payers to validate orders... ...valid California RN License (required)...Daily paidNight shift
$83.25k - $136.22k
...Position Title: RN Nurse Case Manager ll (California HMO)... ...responsible for performing care management within the... ...plans designed to optimize member health care... ...with development of utilization/care management policies... ...under Florida law should review the education and...Full timeTemporary workWork experience placementWork at officeLocal areaShift work1 day per week$1,900 - $2,500 per week
...Job Title: Travel RN Case Management Utilization Review Location: Carmichael, CA Salary Range: From $1,900 to $2,500 per week Shift: 8-hour... ...crucial for ensuring that patients receive appropriate care while managing healthcare resources effectively. Key...Weekly payContract workRelocationMonday to FridayShift workDay shift- ...Utilization Review Case Manager Align yourself with an organization that has a reputation... ...highest-quality medical care in Los Angeles. We were... ...collaboration and communication with payers as required. The UR Case... ...preferred. California RN License required....Daily paidSeasonal work
$88.85k
...Utilization Management Claims Review Nurse RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 900... ...Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by...Full time- ...qualified Registered Nurse to provide utilization review and coordinate care across the healthcare continuum. Candidates should possess a California RN license and have at least three years of experience in utilization management and clinical settings. The role requires...
- Cedars-Sinai in Los Angeles is seeking a utilization review nurse. The role involves validating... ...associate degree in nursing, current RN state license, and relevant experience... ...bachelor's degree in nursing along with case management experience. This position requires...Shift work
$2,066 per week
...GQR Healthcare is seeking a travel nurse RN Acute Care Case Management for a travel nursing job in Los Angeles, California. Job Description... ...Employment Type: Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Los Angeles, California...Hourly payWeekly payContract workShift work$7,000 per month
...Inpatient Case Manager This position offers a sign on bonus! $10k for RN & $7k for LVN The Inpatient Case... ...during an acute care episode. Assesses and... ...severity of illness, utilizing the appropriate tests... ...needs. Receives and reviews physician's orders; documents...Hourly payFull timeCasual workWork at officeImmediate startRelocation packageFlexible hours- ...RN Case Manager Qualifications for RN Case Manager: The Case Manager... ...for managing a continuum of care from admission through... ...Partners with medical staff, utilizes scientific evidence for best... ...employee performance through the review of completed work assignments...Temporary workShift work
$2,365.11 - $2,460.11 per month
...Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Glendale, California Start Date: January 20, 2026 Profession: Registered Nurse (RN) Facility: Short Term Acute Care Estimated Pay: $2365.11 - $2460.11 Duration:13...Hourly payWeekly payContract workTemporary workShift work$93.83 per hour
...assessing and coordinating care for a diverse group of... ...care plans utilizing evidence-based tools for... ...also perform utilization review while assuring the delivery... ...Nursing staff) CA RN License and BLS... ...Recent experience in case management, utilization management...Hourly payDaily paidRemote workDay shift$65.53 - $84.75 per hour
...assessing and coordinating care for a diverse group of... ...care plans utilizing evidence-based tools for... ...also perform utilization review while assuring the delivery... ...Nursing staff) CA RN License and BLS certification... ...Recent experience in case management, utilization...$65.53 - $84.75 per hour
...assessing and coordinating care for a diverse group of... ...care plans utilizing evidence-based tools for... ...also perform utilization review while assuring the delivery... ...Nursing staff) CA RN License and BLS... ...Recent experience in case management, utilization management...$41 - $55 per hour
...Description As a DaVita Integrated Kidney Care Registered Nurse (RN) Case Manager you will support some of our most... ...system. Through medical record review and consultation, you will identify... ...Care Management ~1+ years of utilization management experience ~ Spanish...Minimum wageFull timeRemote workWork from homeHome officeMonday to FridayFlexible hours- ...Case Manager - RN Per Diem Day Shift Under the general supervision of... ...manager manages clinical resource utilization and documentation affecting... ...Essential Functions: Reviews clinical information daily... ...with members of the health care team in removing barriers to...Daily paidShift workDay shift
- ...Now Hiring: Full-Time RN Case Manager & Educating Supervisor We are dedicated... ...and coordinating patient care, as well as providing... ...healthcare professionals to optimize patient outcomes. Document... ...area for patient visits. Utilize strong computer skills to enhance...Full timeImmediate start
- L.A. Care Health Plan in Los Angeles is hiring a Utilization Management Claims Review Nurse RN II responsible for conducting clinical reviews of medical claims. The position requires a minimum of 5 years in clinical nursing, with experience in Medi-Cal and Medicare managed...
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