Utilization Review RN: Care Coordination & Case Management
Providence Health Plan Group
A leading healthcare organization is seeking a skilled professional to provide utilization review and coordinate care for members in California. The successful candidate will have a Nursing school degree and a California RN License. Key responsibilities include ensuring quality and cost-effective healthcare. Experience in utilization and case management is preferred. Providence offers a comprehensive benefits package including health care benefits, retirement plans, and paid parental leave. #J-18808-Ljbffr Providence Health Plan Group
- ...Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost... ...upon hire. 3 years experience in utilization management and/or case management. 3 years clinical experience in hospital...SuggestedWork at office
$74.29k - $111.43k
...Summary The Concurrent Utilization Review (UR) Nurse is... ...provided to members under a managed care health plan. The role... ...and continued stays, coordinating with healthcare... ...leadership for complex cases, denials, and escalated... ...– Registered Nurse (RN) with an active, unrestricted...SuggestedWork at office$26.41 - $51.49 per hour
...California, MO is seeking a Clinical Member Services Reviewer. The role includes assessing clinical service... ...delivery. The ideal candidate has an active RN license and at least 2 years of experience in hospital or managed care settings. Competitive pay is offered, ranging...SuggestedHourly pay- ...Description Summary:**The RN Case Manager, in collaboration... ...plan of care for patients, determining... ...and retrospective case review. This position functions... ...recent experience in utilization review and/or discharge... ...Modifiable)****Care Coordination*** Works with the healthcare...SuggestedDaily paidShift work
$74.29k - $111.43k
NeueHealth in California is seeking a Concurrent Utilization Review Nurse responsible for conducting clinical reviews to ensure the medical... ...necessity and appropriateness of services provided under a managed care plan. The role requires 2-3 years of clinical experience,...Suggested- ...automated systems to review applications.... ...applications carefully and respectfully... ...the Medicare Care Management Manager (RN), this position:... ...into the Care Coordination program with the... ...and practices of case management and coordination... ...and means of utilizing community...Full timeTemporary workPart timeWork experience placementLive inWork at officeLocal areaRemote work
$160k
Care Coordination Case Management Nurse — Southern California Hospital Opportunity The Care Coordination... ...nurses, physicians, social workers, utilization review specialists, and a diverse team of... ...explore this hospital case management RN opportunity—spark the next step in...$74.56 - $90.51 per hour
...Summary and Responsibilities Day Full Time RN Care Coordinator The RN Care Coordinator is... ...communication and collaboration with utilization management nursing physicians, ancillary departments... ...experience - or a Masters degree in Case Management or Nursing field in lieu of...Hourly payFull time- ...Executive Service Corps is seeking an RN Case Manager-Pre Access in California. This... ...and facilitating admission reviews for acute patients. The ideal candidate... ...and has experience in an acute care setting. Responsibilities include coordinating patient transfers and ensuring...
$44.42 - $61.2 per hour
...Summary Registered Nurse (RN) – Care Management – hybrid remote and in-field... ..., adherence; coordinate with providers and pharmacies... ...team members; participate in case reviews, huddles, and interdisciplinary... ...avoidable hospital or ED utilization, adults at risk of LTC institutionalization...Hourly payLocal areaRemote work- ...The RN Utilization Management (RN UM) functions as a support liaison for a variety... ..., and the UM process. Coordinates care submission relating to the... ...hospital stays, and discharge review that determine medical... ...years recent experience in Case Management or Utilization...Full timeLocal area
- ## Social Work Case Manager LCSW I, Care Coordination, Per Diem, DaysApplylocations: Greenbrae, CAtime type... ...thinking skills necessary to provide utilization review/discharge planning services... ...model comprised of SW Case Manager, RN Case Manager, and Case Management...Daily paidWork experience placementInternshipWork at officeShift work
$55 per hour
...Akkodis is hiring a Concurrent Review Nurse to support our client... ...for ensuring that member care is provided at the most appropriate... .... Preferred: Experience in case management, utilization management, or discharge... ...within the scope of RN practice in California. Ability...Full timeContract workTemporary workLocal areaRemote work$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location... ...Provider and Care Teams Operate with Integrity... ...medical equipment Refer cases to Medical Directors as needed... .... Candidates with only case management experience are not a fit....Hourly payRemote workMonday to Friday- ...and Responsibilities Nurse Manager of Care Coordination / Case Management Sign On /... ...staff performance management, reviewing or gathering of data to promote... ..., discharge planning, utilization review and social work interventions... ...Experience: Current CA RN licensure. Minimum of...Local areaRelocation
$30.37 - $59.21 per hour
Molina Healthcare in California seeks a Clinical Reviewer to support member service assessments and ensure services align... ..., and collaborating with teams to optimize member care. The ideal candidate holds an active RN license and brings at least 2 years of experience. Molina...Hourly pay- SCAN Group in California seeks a Medical Management Specialist-LVN to ensure quality care for members. The role involves managing complex medical cases and applying utilization management principles to support care coordination. To be successful, candidates must have a...Remote job
$98.55k - $147.83k
...conventional health care, committed to... ...experienced Manager of Care Management... ...in outpatient case management,... ...optimal resource utilization across the continuum... ...for a proven RN leader who is... ...care, and care coordination Maintain audit... ...coordinating chart reviews and monitoring...Remote jobWork at office$35 - $50 per hour
...person Job Description Summary The LVN Care Coordinator is responsible for ensuring that patient care is coordinated and managed appropriately. The LVN Care Coordinator... ...Functions / Responsibilities Receives case referrals. Reviews available patient information related to...Immediate startMonday to Friday- ...America). Job Summary The RN Care Manager - Primary Care is... ...the delivery of care coordination services for specific... ...and continuously review the plan of care to facilitate... ...experience in Case Management, or Care Coordination... ...: Certification in Utilization Review and/or Case...Work at officeShift work
$45 per hour
...remotely from California. The role involves reviewing medical records and ensuring compliance... .... Ideal candidates will have strong managed care and clinical nursing experience, exceptional... ...communication skills. A California RN license and ADN are required. The position...Hourly payRemote work$66.03 - $99.04 per hour
Marin General Hospital is seeking an RN Case Manager to lead the development of patient care plans and ensure effective, efficient care. The role requires a... ...acute care setting. Responsibilities include care coordination, discharge planning, and collaboration with healthcare...Hourly pay- Job Description The Case Manager Care Coordinator coordinates the care and service of patient populations... ...effective care coordination and utilization of healthcare resources in order to achieve... ...Licenses and Certifications RN State License - upon hire, minimum acute...Daily paidAfternoon shift
- Santa Rosa in California is looking for a Registered Nurse Case Manager to oversee the planning and coordination of patient care from pre-hospitalization through discharge. The role requires collaboration with the health care team to ensure effective treatment and education...
- ...California, United States seeks a clinical co-pilot to coordinate patient care effectively. The ideal candidate will have a BSN and a current RN license. This role demands a minimum of 3 years in case management and requires proficiency in patient care coordination. Join...
$26.41 - $51.49 per hour
...clinical member services review assessment processes.... ...delivery of care across the continuum.... ...Refers appropriate cases to medical directors (... ...model. Adheres to utilization management (UM) policies and procedures... ...Registered Nurse (RN). License must be active...Hourly payWork experience placementWork at officeRemote work$26.35 - $39.53 per hour
...entitled to high-quality, coordinated care. By uniquely aligning... ...The Concurrent Utilization Review (UR) Nurse is responsible... ...to members under a managed care health plan.... ...leadership for complex cases, denials, and escalated... ...: Registered Nurse (RN) or Licensed Vocational...Hourly payWork at officeRemote work- ...Services is looking for a qualified RN to perform clinical reviews, ensure compliance with medical necessity... ...should have experience in case management and prior authorization, with a proactive... ...focused on maintaining high-quality care standards in a dynamic environment....
$27.61 - $53.83 per hour
...for clinical member services review assessment processes.... ...through integrated delivery of care across the continuum. Contributes... .... Refers appropriate cases to medical directors (MDs) and... ...Molina care model. Adheres to utilization management (UM) policies and procedures...Hourly payContract workWork experience placementWork at office- ...Lot is seeking a Registered Nurse for Utilization Management in California. The RN UM will support various UM functions including care coordination, denials management, and insurance authorization... ...RN license, and experience in Case or Utilization Management. This role...
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review RN: Care Coordination & Case Management. Be the first to apply!
- rn relocation bonus California, MO
- flex rn California, MO
- charge registered nurse California, MO
- ccu rn California, MO
- international registered travel nurse California, MO
- registered nurses covid-19 California, MO
- interventional radiology rn California, MO
- rn risk management California, MO
- travel clinic rn California, MO
- rn quality California, MO

