Utilization Review RN
$57.28 - $88.92 per hourProvidence
Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost‑effective care to the members. Providence caregivers are valuable participants in a patient‑focused, whole‑person care culture that values commitment and mutual respect. Required Qualifications Nursing school graduate. California Registered Nurse License upon hire. 3 years of experience in utilization management and/or case management. 3 years of clinical experience in a hospital or medical office/clinic setting. Experience with Milliman criteria. Preferred Qualifications Bachelor's Degree in Nursing or a related field. Certification in Case Management (CCM) upon hire. Benefits Providence offers a comprehensive benefits package that includes a retirement 401(k) savings plan with employer matching, medical, dental, and vision coverage, life and disability insurance, paid parental leave, vacations, holidays, health‑issue leave, voluntary benefits, and well‑being resources. Additional compensation may be available such as shift differentials, standby/on‑call, overtime, and bonus opportunities. Equal Opportunity Employer . The company is committed to a workplace free from unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity, marital status, genetic information, or any other basis prohibited by local, state, or federal law. Requisition ID: 424324 Company: Providence Jobs Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Per‑Diem Job Shift: Variable Career Track: Nursing Department: 7520 UTIL MGMT CA HERITAGE Address: CA Mission Hills 15451 San Fernando Mission Blv Work Location: Facey Medical Foundation Admin Office-Mission Hills Workplace Type: Hybrid Pay Range: $57.28 - $88.92 #J-18808-Ljbffr Providence
$57.28 - $88.92 per hour
...Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost‑effective care to the members. Providence caregivers are valuable participants in a patient‑focused, whole‑person care culture...SuggestedDaily paidWork at officeLocal areaShift workPROVIDENCE, INC.
Los Angeles, CA1 day ago$88.85k
...income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for conducting clinical review of medical claims to ensure services were medically...SuggestedFull timeL.A. Care Health Plan
Los Angeles, CA5 days ago- Air Combat Effectiveness Consulting Group, LLC in Monterey Park is seeking a Case Manager RN or LVN to join our Utilization Review Department. This per diem position involves coordinating care for patients, conducting admissions, and liaising with health plans to ensure...SuggestedDaily paid
- ...seeks a dedicated Registered Nurse in Los Angeles to provide utilization review and care coordination. You will be integral to ensuring quality... ...The role requires a Nursing school graduate with a California RN license, along with at least 3 years of experience in utilization...Suggested
$71k - $151k
Incredible Health is seeking Registered Nurses for Utilization Review roles in Los Angeles, CA. Candidates should possess an RN Diploma or higher and an active license in California. The job offers both full-time and part-time positions. In addition to competitive salaries...SuggestedFull timePart timeDay shift- 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...
$71k - $151k
...Registered Nurse - Utilization Review Hospitals on Incredible Health are hiring and accepting applications in the Los Angeles, CA area. Work Details... ...Job types available: full time and part time Qualifications RN Diploma degree or higher from an accredited school of nursing...Full timePart timeShift workDay shiftIncredible Health
Los Angeles, CA4 days ago$30 - $34 per hour
...A health services company is seeking a Utilization Management Review Nurse in Monterey Park, CA. This hybrid role includes conducting reviews for inpatient admissions and outpatient procedures, ensuring compliance with regulations, and working collaboratively with the...Hourly payWeekend workAstrana Health
Monterey Park, CA1 day ago$74.16 - $107.75 per hour
...Description The Utilization Review Nurse is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital, supporting inpatient, partial hospital, and intensive outpatient programs. Performs clinical reviews with third party payors in order to...UCLA Outpatient Clinics
Los Angeles, CA5 days ago- ...Nurse Manager Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures... .... Provides direction to staff regarding utilization review, care coordination, discharge planning, and other services across...Local area
$47.2 - $63.45 per hour
...to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service... ...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. 3. Five years acute care nursing experience...Full timePart timeWork experience placementLocal areaShift workPrime Healthcare
Lynwood, CA2 days ago$74.16 - $107.75 per hour
...UCLA Outpatient Clinics is seeking a Utilization Review Nurse for its Utilization Management Department at the Resnick Neuropsychiatric Hospital in Los Angeles, California. This role supports inpatient, partial hospital, and intensive outpatient programs by performing...Hourly payUCLA Outpatient Clinics
Los Angeles, CA5 days ago- Astrana Health Management is seeking a CA-licensed UM Review Nurse to review outpatient medical services. Candidates should have 1+ years of outpatient Utilization Management experience, work remotely, and maintain availability for shifts 8 AM - 8 PM PST, Monday through...Remote jobShift work
$27.61 - $53.83 per hour
Molina Healthcare in Los Angeles, California is seeking a qualified candidate to provide support for clinical member services assessment processes. The role involves verifying medical necessity and ensuring compliance with clinical guidelines. Ideal candidates will have...Hourly pay$27.61 - $53.83 per hour
...DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services... ...teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures. Required Qualifications...Hourly payContract workWork experience placementWork at office- ...California. In this role, you'll be responsible for reviewing outpatient precertification requests and ensuring... ...and continuity of services. A current California RN or LVN license and 2+ years of experience in utilization management are required. Proficiency in Microsoft...Work at office
$74.16 - $107.75 per hour
Veterans in Healthcare is looking for a Utilization Review Nurse to work in Los Angeles, CA. This role is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital and supports various treatment programs. The ideal candidate will perform clinical...Hourly payMonday to Friday$30 - $34 per hour
...Center Dr., Monterey Park, CA 91754 Compensation: $30.00 - $34.00 / hour Department: Health Services (HS - UM) Job Title Utilization Management Review Nurse About the Role Astrana Health is looking for a Utilization Review Nurse to assist our Health Services Department....Hourly payWork at officeMonday to FridayShift workAstrana Health
Monterey Park, CA5 days ago- ...POSITION SUMMARY The RN Utilization Management (RN UM) functions as a support liaisons for a variety of UM functions which may include... ...admissions with continued and extended hospital stays, and discharge review that determine medical necessity. The RN UM will complete and...Full time
- ...Description Job Description: Manager of Clinical Utilization Management - Denial Compliance... ...staff, managing daily tasks, performance reviews, and any necessary disciplinary actions.... ...an accredited Registered Nursing Program; RN preferred. 2. Minimum of five years in...Permanent employmentFull timeTemporary workRemote workFlexible hours
- Rheumatology (MD/DO) Utilization Review - Remote Contract (1099) Apply for this independent contractor position with Medical Review Institute of America. Flexible Independent Contractor (1099) Opportunity Fully remote, 1-2 hours per week, no minimum commitment. Covered...Remote jobContract workFor contractorsFlexible hours
$37.6 - $78.35 per hour
...for conducting comprehensive facility site reviews (FSRs) to ensure compliance with... ...Education & Disease Management Programs utilizing established interventions, performing necessary... ...timely manner Qualifications Current LVN or RN licensure in the state of California...Hourly payWork at officeRemote workDirect Jobs
Los Angeles, CA5 days ago- ...MedPOINT Management as a Medical Claims Clinical Review Nurse in Sherman Oaks, CA, where you'll... ...information and resolve discrepancies. Utilize clinical knowledge to assess the medical... .... Requirements: Registered Nurse (RN) license in California is required. Minimum...Remote work
MedPOINT Management
Los Angeles, CA17 days ago - ...Technician on the Hemodialysis Treatment Sheet. Reviews, transcribes, and enters physician lab... ...lab. Ensures correct lab tubes are utilized for prescribed lab specimens and that lab... ...Group Float position, multi‑state/compact RN licenses Dialysis Experience required. #J...ReliefImmediate startShift work
Fresenius Medical Care
Glendale, CA1 day ago - ...Clinical Nurse Reviewer As one of the fastest growing Independent Physician Associations in Southern California, our organization offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people...Work experience placementFlexible hours
- Direct Jobs is seeking a Utilization Management Nurse in Los Angeles, CA, to support level-of-... ...flow. The Nurse will conduct utilization reviews, ensure timely access to care, and work closely... ...in psychiatric nursing, and a current CA RN license. The role includes participation...
- ...staff and appropriate community agencies. Reviews, monitors, evaluates and coordinates the... ...providing continuity of care, including Utilization management, Transfer coordination, Discharge... ...Experience Two (2) years combined RN experience in an acute care setting or case...Contract workPart timeLocal areaShift workWeekend work
- Working Nurse is seeking a Utilization Management Claims Review Nurse RN II in Los Angeles. This full-time position involves clinical review of medical claims to ensure services are warranted and compliant with regulations. The ideal candidate will have at least 5 years...Full time
- ...Martin Luther King, Jr. Community Hospital in Burbank, California, is seeking a Registered Nurse for the RN Utilization Management position. The RN will act as a support liaison for various UM functions including case management and denials management, coordinating care...
Martin Luther King Jr. Community Hospital
Burbank, CA2 days ago $82.16k - $143.34k
...prisoners in City jails. Duties performed include the following: utilizing protocols in the provision of care; assisting the medical staff... ...day. Selection Process Examination Weight: Application Review 100%. The examination will consist entirely of review of candidates...Full timeFlexible hoursShift workNight shiftGovernmentJobs.com
Los Angeles, CA6 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review RN. Be the first to apply!
- rn network Los Angeles, CA
- registered nurse on call Los Angeles, CA
- telephonic rn Los Angeles, CA
- travel or rn Los Angeles, CA
- labor and delivery registered nurse rn Los Angeles, CA
- pcu rn Los Angeles, CA
- full-time registered nurse rn Los Angeles, CA
- private practice rn Los Angeles, CA
- postpartum rn Los Angeles, CA
- new graduate rn Los Angeles, CA