RN Utilization Review & Case Management Specialist
$50 - $60 per hourNeier Inc.
Neier Inc. in San Diego, California is seeking a Registered Nurse for utilization review responsibilities. The role includes managing admission reviews, conducting concurrent stay reviews, and preparing payment appeals. Applicants must hold a California RN licence and have experience in case management. The position offers a pay range of $50/hr to $60/hr, along with a comprehensive benefits package including health insurance, 401(k), and tuition reimbursement. #J-18808-Ljbffr Neier Inc.
$50 - $60 per hour
...-disciplinary treatment team reviewing patient care and treatment options... ...appropriate records of the Utilization Review Department. Training:... ...relatively independently, manage multiple tasks, and meet deadlines... ...with Utilization Review/Case Management. Benefits 401(k) Retirement...SuggestedFull timeTemporary workWork experience placementWork at officeMonday to Friday- JOB SUMMARY Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center... ...based Nurse Manager that supports Case Management. This is the department... ...to staff regarding utilization review, care coordination, discharge planning...SuggestedLocal area
$132.6k - $259.8k
Description The Manager of Utilization Management supervises Nurse Case Manager and Referral Coordinator staff responsible for Managed Care Utilization Management... ...complex cases as needed for Medical Director review or Assistant Director UM/ Director of PHSO. Coordinates...SuggestedHourly payWork at officeWeekend work2 days per week1 day per week- Blue Shield of CA is seeking an RN leader for its Utilization Management team. The role focuses on independent... ...utilization and retrospective clinical reviews across lines of business,... ...timeliness, and escalation of high-risk cases. #J-18808-Ljbffr Blue Shield of CASuggested
$64.74 - $79.23 per hour
...patient advocate, and manages patients in the most cost... ...community agencies. Reviews, monitors, evaluates, and... ...of care, including utilization management, transfer coordination... .../agencies and provides case management to patients... ...Two (2) years combined RN experience in an acute...SuggestedHourly payFull timeWork experience placementLocal areaMonday to FridayShift workWeekend work$22 - $25 per hour
...motivated full-time Lead Care Manager who is willing to think... ...practitioner and Community Engagement Specialist with delegated tasks... ...participating in systematic case reviews and consulting with nurse care... ...and internal providers Utilize external and internal online...Full timeWork experience placementLocal areaRemote workWork from homeFlexible hours$22 - $25 per hour
...Bilingual Case Management Specialist (Remote Flexible, Spanish Speaking) San Diego, California... ...caseload of individuals through the utilization of evidence based approaches to promote... ...by participating in systematic case reviews and consulting with nurse care manager...Full timeWork experience placementLocal areaRemote workWork from homeFlexible hours$18 - $20 per hour
...Transaction Review Specialist San Diego, California, United States At ecoATM the proof of our success is in our staggering growth, extraordinary... ...more than just a job, you will be empowered to develop and utilize your unique talents and skills to build a rewarding career...Hourly payFull timeTemporary workLocal areaFlexible hoursNight shiftAfternoon shift$19.47 - $38.08 per hour
...millions. Under the general direction of the Utilization Management Manager, you will be responsible for prospective and concurrent/retrospective review of referrals ensuring regulatory... ...Coordinate out-of-network and out-of-area cases with members' health plans and the Case...Hourly payMinimum wageWork experience placementWork at officeLocal areaWork from home- .... Job Summary MAAC’s utilities assistance programs include... ...information into data management systems, and... ...and files. The Program Specialist will work to support MAAC... ...and Responsibilities Review submitted/assigned applications... ...audits of case files to ensure eligibility...For contractorsWork at officeLocal area
- ...for clinical member services review assessment processes.... ...timelines. Refer appropriate cases to medical directors (MDs) and... ...Molina care model. Adhere to utilization management (UM) policies and procedures... .... Registered Nurse (RN). License must be active and...Work at office
- ...Clinical Member Services Reviewer Job Description Job Summary... .... Refers appropriate cases to medical directors (MDs) and... ...Molina care model. Adheres to utilization management (UM) policies and procedures... .... Registered Nurse (RN). License must be active and...Work at office
- ...Job Description Job Summary Provides support for facility site review activities including routine document preparation and file management, site review meeting/travel scheduling, and office supply ordering. Facilitates activities including training and reporting...Work at office
- A nonprofit social service organization in California seeks a Program Specialist to assist low-income households with their utility bills through eligibility determination and application assistance. The role requires proficiency in data entry and a strong understanding...
- (RN) Manager - Utilization Management The Manager of Utilization Management supervises Nurse Case Manager and Referral Coordinator staff responsible for Managed Care Utilization Management (UM), following regulatory and compliance as it relates to delegation for commercial...
$2,605 per week
...Registered Nurse (RN) | Case Manager Location: San Diego, CA Agency: Prime Staffing... ...profile has been sent to the manager for review. RTO: Screenshot of traveler confirming... ...clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing...Permanent employmentFull timeContract workTemporary workLocal areaImmediate startShift workNight shiftWeekend work$100k
...adult care, chronic disease management, pediatrics, comprehensive women... ...obstetrics, dental, vision, case management, physical... ...Description *The Healthcare Enrollment Specialist is responsible for providing... ...statistics as needed. Utilizes an enrollment verification system...Full timeLocal area$150k - $325k
Role CPAAudit Director & Reviewer (Remote - GAGAS/OMB Specialist) Compensation $150,000 - $325,000+ (Based on... ...our team. AI Integration: Actively utilize and oversee Agentic AI tools to... ...for those who demonstrate they can manage larger file volumes using AI efficiency...Remote jobWork at officeImmediate start- ...is seeking an experienced Nurse Manager to oversee the day-to-day operations of the Utilization Management Program. This role involves... ...in utilization management and case management, alongside a BSN or... ...experience is necessary, and a California RN license is required. #J-18808-...
- ...build a high-impact Care Management program in a value-... ...We’re hiring a hands‑on RN leader to build and lead... ...This is not a traditional case management role. We are... ...in quality, utilization, and patient outcomes—particularly... ...utilization management reviews Analyze utilization...Contract workRemote workFlexible hoursAfternoon shift
$90k - $110k
...Transforming Lives Optima Medical Management Group is dedicated to... ...fulfilling work! Job Summary The RN Clinical Case Manager provides clinical... ...medical history, diagnoses, utilization patterns, medications, and risk indicators. Develop, review, and clinically approve...Full timeTemporary workLocal areaImmediate startFlexible hours- ...SRS RN CM II Shift Start Time: 7:30 AM Shift End Time: 4 PM AWS Hours... ...considerations with regulatory/financial/utilization review demands to assure patients are... ...Years acute care nursing experience or case management experience ~3 Years recent case management...Hourly payDaily paidShift workWeekend work
- ...disabilities to perform essential job functions. Provide injections, medication support, diagnostic reviews, case consult, crisis intervention, and targeted case management services to assist clients with basic needs and symptom management. Accurate and timely...Work at officeShift work
- ...The RN would be on call from Friday at 4:30 pm until Monday at 8:00 am. The RN would... ...and disease prevention or provide case management. Licensing or registration is required.... ...tasks, including vital signs and medication reviews Coordinate with physicians, therapists...Local area
- ...The ECM Case Manager will assume responsibilities for community outreach and engagement. This position will determine eligibility, complete... ...of the Care Plan. Supports health behavior change utilizing motivational interviewing and trauma‑informed care practices....Work at officeRemote work
- ...and evaluate patient progress. Responsibilities Provide injections, medication support, diagnostic reviews, case consult, crisis intervention, and targeted case management services to assist clients with basic needs and symptom management. Accurate and timely...Work at officeShift work
$85k - $95k
...trades. As a Professional Tool Specialist, you will sell, promote, and... ...to the Regional Sales Manager for the West Region. Your job... ...the Electrical, Mechanical, Utility, Plumbing, and Industrial segments... ...performance during our annual merit review process. The salary range for...Temporary workApprenticeshipLocal areaFlexible hours- ...Asset Management Specialist Are you a skilled asset management professional with a demonstrated ability... ...Department reports directly to the Utility Services Manager and plans, organizes,... ...and works with Department staff to review and develop maintenance schedules, repair...For contractors
$73k - $135k
...Job Title Specialist, Procurement Job Code 35018 Job Location San Diego... ...to meet required schedules. Reviews proposals, negotiates prices,... ...with purchasing and managing suppliers for electronic components... ...tools are compliant and properly utilized to meet all established work...For contractorsLocal areaFlexible hours- ...Asset Protection Specialist Position Purpose: The Asset... ...multiple stores. They utilize tools to minimize loss... ...of theft and fraud, reviewing CCTV and exception... ...accurate and detailed case reports documenting your... ...unsafe condition to the Manager on Duty and carry out...
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