Utilization Management RN
$99.31k - $131.09kWelbeHealth
Utilization Management RN
At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, functioning as both a care provider and care plan to those individuals we serve.
Our Health Plan Services team plays a critical role in our participant's journey and our Utilization Management team ensures we can provide timely, quality, compliant, and cost-effective care to our participants. By guiding this team, the Utilization Management RN Supervisor drives the continuous improvement of our care delivery processes.
Essential Job Duties
- Direct oversight of day-to-day operations within the designated UM team
- Assist the team in reviewing prior-authorization requests for medical necessity and appropriateness
- Identify, develop, and provide orientation and competency development for staff processing and/or reviewing authorizations
- Collaborate with providers (internal and external), clinical staff, and others to timely resolve any utilization management issues
Job Requirements
- Minimum of three (3) years of relevant clinical nursing experience
- Strong preference for prior PACE experience
- Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team members
Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.
- Medical insurance coverage (Medical, Dental, Vision)
- Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and sick time
- 401K savings + match
- Advancement opportunities - we've got a track record of hiring and promoting from within, meaning you can create your own path!
- And additional benefits
Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.
$99,309.58 - $131,088.64 USD
COVID-19 Vaccination Policy
At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.
Our Commitment to Diversity, Equity and Inclusion
At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
Beware of Scams
Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to View email address on click.appcast.io
- ...An established industry player in healthcare is seeking a dedicated Utilization Management Nurse to enhance patient care efficiency. In this vital role, you will review patient files and treatment methods, ensuring that every patient receives the necessary treatments...SuggestedRelocation package
Presidential Staffing Solutions, LLC
Los Angeles, CA4 days ago - ...The RN Utilization Management (RN UM) functions as a support liaison for a variety of UM functions which may include the e‑TAR process, denials management, and the UM process. Coordinates care submission relating to the process of health care utilization from the point...SuggestedFull timeLocal area
Ocean State Job Lot
Los Angeles, CA4 days ago $99.31k - $131.09k
...reviewing authorizations Collaborate with providers (internal and external), clinical staff, and others to timely resolve any utilization management issues Job Requirements Minimum of three (3) years of relevant clinical nursing experience Strong preference for prior PACE...SuggestedWelbeHealth
Los Angeles, CA4 days ago- ...Direct Jobs is seeking a Utilization Management Nurse in Los Angeles, CA, to support level-of-care determination and optimize patient flow. The... ...years of experience in psychiatric nursing, and a current CA RN license. The role includes participation in quality improvement...Suggested
Direct Jobs
Los Angeles, CA4 days ago $41.38 - $69.02 per hour
...Anticipated End Date: 2026-07-10 Position Title: RN Utilization Management Nurse (InPatient) - California HMO Job Description: RN Utilization Management Nurse (InPatient) - California HMO Virtual: This role enables associates to work virtually full...SuggestedFull timeTemporary workWork experience placementWork at officeLocal areaShift work1 day per weekElevance Health
Los Angeles, CA2 days ago$116.3k - $264.6k
...exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you’ll provide direct management to a team of UM coordinators and nurses. You’ll work closely with Medicare...UCLA Health
Los Angeles, CA4 days ago- ...L.A. Care Health Plan is seeking a Supervisor of Utilization Management RN to lead the daily operations of the UM department in Los Angeles. This role requires extensive clinical experience and supervisory skills to ensure department efficiency and quality care delivery...Full time
L.A. Care Health Plan
Los Angeles, CA1 day ago - ...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...
L.A. Care Health Plan
Los Angeles, CA5 days ago $88.85k
...Utilization Management Claims Review Nurse RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 13077 Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142...Full timeL.A. Care Health Plan
Los Angeles, CA3 days ago- ...MedPOINT Management is hiring a UM Outpatient Licensed Clinician in Los Angeles, California. In this role, you... ...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
MedPOINT Management
Los Angeles, CA5 days ago - ...Ocean State Job Lot is seeking an RN for Utilization Management in Los Angeles, CA. This role involves coordinating care submissions and documentation for patient admissions, focusing on high-quality care and efficiency. Candidates must hold an Associate's Degree in Nursing...
Ocean State Job Lot
Los Angeles, CA5 days ago $116.3k - $264.6k
...UCLA Health is seeking a leader for Intensive Case Management and Utilization Management programs in Los Angeles. This role involves supervising a... ...transitions. The ideal candidate will have a Bachelor's in Nursing, RN licensure in California, and several years of experience in...UCLA Health
Los Angeles, CA4 days ago$102.18k
...Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 13160 Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max...Full timeL.A. Care Health Plan
Los Angeles, CA4 days ago- ...Martin Luther King, Jr. Community Hospital is looking for an RN Utilization Management professional to function as a support liaison for various utilization management tasks, focusing on care coordination from patient admission to discharge. The ideal candidate will possess...
Martin Luther King Jr. Community Hospital
Pasadena, CA2 days ago $116.3k - $264.6k
...UCLA Outpatient Clinics is looking for an experienced Utilization Management Assistant Director in Los Angeles. In this key leadership role, you will oversee Intensive Case Management and Utilization Management operations, ensuring high-quality patient care across complex...UCLA Outpatient Clinics
Los Angeles, CA2 days ago- ...Martin Luther King, Jr. Community Hospital is looking for a dedicated RN Utilization Management nurse to manage healthcare utilization from admission to discharge. You will coordinate care documentation and work closely with the insurance team to ensure high-quality care...
Martin Luther King Jr. Community Hospital
Los Angeles, CA1 day ago $52.25 - $80.99 per hour
...MLK Community Healthcare is looking for an RN Utilization Management to oversee the coordination of care submissions and manage clinical denials. The role requires an Associate's Degree in Nursing, with preference for a BSN, and a California Registered Nurse License. Responsibilities...Hourly payMLK Community Healthcare
Los Angeles, CA5 days ago- ...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, CA15 hours ago $116.3k - $264.6k
...UCLA Health is seeking an experienced Utilization Management Assistant Director to oversee Intensive Case Management and Utilization Management... ...operational excellence. The ideal candidate will have a BSN, RN licensure in California, and significant experience in case management...Case Management Society of America Inc
Los Angeles, CA2 days ago- Martin Luther King, Jr. Community Hospital is seeking a skilled RN Utilization Management professional to function as a support liaison for various UM functions. The role involves coordinating care from admission to discharge, managing clinical denials, and ensuring adherence...
$116.3k - $264.6k
...Provide day-to-day leadership and oversight of Intensive Case Management (ICM) and Utilization Management (UM) programs Supervise and mentor a... ...Qualifications All items are required: Current unrestricted RN licensure in CA required Bachelors of Science, Nursing (BSN...Work at officeUCLA Health
Los Angeles, CA4 days ago- Martin Luther King, Jr. Community Hospital is hiring an RN Utilization Management professional to coordinate patient care related to utilization management functions, including pre-authorizations and clinical reviews. This role demands a strong understanding of health care...
$116.3k - $264.6k
...Direct Jobs is seeking an experienced Utilization Management Assistant Director to lead Intensive Case Management and Utilization Management operations... ...with regulations. The ideal candidate will have a BSN, RN licensure in California, and significant experience in management...Direct Jobs
Los Angeles, CA2 days ago$116.3k - $264.6k
...Yourcommission is seeking a Utilization Management Assistant Director in Los Angeles to lead Intensive Case Management and Utilization Management... ...improving patient outcomes. Ideal candidates possess a BSN, active RN license in CA, and experience in management roles within...yourcommission
Los Angeles, CA2 days ago- Martin Luther King, Jr. Community Hospital is seeking an RN Utilization Management to act as a support liaison across various UM functions. This role ensures patient care efficiency from admission to discharge, including management of the clinical denials process. The ideal...
- ...Neuehealth is seeking a Concurrent Utilization Review Nurse in Los Angeles, CA. This vital role involves conducting real-time clinical... ...to ensure the medical necessity of healthcare services under managed care health plans. Responsibility includes collaborating with...
NeueHealth
Los Angeles, CA2 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...Daily paid
Air Combat Effectiveness Consulting Group LLC
Monterey Park, CA2 days ago $47.58 - $76.68 per hour
...requirements and policies. The role demands a current California R.N. license and preferably a BSN, alongside experience in utilization and quality management. Compensation ranges from $47.58 to $76.68 hourly, reflecting the expertise required for this role. #J-18808-Ljbffr...Hourly payUniversity of Southern California
Glendale, CA1 day ago- ...UCLA Health is seeking a Utilization Management Nurse in Los Angeles, California. This role involves supporting appropriate level-of-care determination... ...of psychiatric nursing experience, possess a current CA RN license, and be BLS certified. This position may convert to a...
UCLA Health
Los Angeles, CA4 days ago $74.16 - $107.75 per hour
...Description The Utilization Management (UM) Nurse supports appropriate level‑of‑care determination, patient flow, and revenue cycle integrity across... ...nursing care experience required. Current valid CA RN license, required BLS from the ARC or AHA, required. Prior case...Work at officeCase Management Society of America Inc
Los Angeles, CA4 days ago
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