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Utilization Management Admissions Liaison RN II Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) L.A. Care Health Plan is an independent public agency created by the state of California to provide health...

Registered Nurse (RN) For Utilization Management Team We are seeking a Registered Nurse (RN) to join our Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical necessity reviews,...

Responsible for utilization review work for emergency admissions and continued stay reviews Responsibilities Review and evaluate electronic medical records of emergency department admissions and screen for medical...

Medical Solutions is seeking a local contract nurse RN Case Management for a local contract nursing job in Paramount, California. Job Description & Requirements Specialty: Case Management Discipline: RN...

Santa Barbara Cottage Hospital is seeking an experienced RN/LPN to perform remote clinical reviews for appeal cases. You will review medical records, apply InterQual criteria, and prepare clinical determinations for physician review. The...

Rio Hondo Subacute and Nursing Center in Montebello, CA is seeking a Full-Time Case Manager (LVN/LVN) to oversee care delivery from pre-admission to post-admission. You will ensure care coordination and appropriate utilization of services to...

TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective, appropriate utilization of Behavioral Health and Medical/Surgical services.

Centene is seeking an experienced RN (or LPN/LVN) with 4+ years in clinical nursing or case management to serve as a liaison for statewide appeals and external reviews. You will ensure NCQA and state compliance, prepare appeal letters, and...

Resp & Qualifications We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for...

Nurse - Clinical Review Performs utilization review of cases to determine if the request meets medical necessity criteria in accordance with medical policies agreed upon with the Client and any applicable governing body. Facilitates...

Job Summary: The LVN Case Manager works under the direction of an RN following assessment, planning, facilitation and advocacy, which are achieved through collaboration with the client and other health care...

Nurse Supervisor (Nurse Triage) Location: Remote Department: Nurse Triage Employment Type: Full-Time, Exempt Reports To: Nurse Manager/VP of Operations Direct Reports: Registered Nurses...

Job Title Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital...

University of Miami Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for prior authorization, concurrent and retrospective utilization, coordinating with the care team for timely and...

Contract Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and...

Job Description: The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments, and evaluations. This role involves developing and implementing...

Devoted Health Services, Inc. is seeking an experienced registered nurse to perform comprehensive clinical reviews across pre-service, concurrent, and post-service cases within a fast-paced Utilization Management environment. You will...

Clinical Specialist Base Compensation Range $72,000 - $85,000 USD Compensation & Benefits Competitive cash compensation Comprehensive health plans Generous PTO Future focused 401k match...

Position Summary Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality,...

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and...

Aya Healthcare has an immediate opening for the following position: Case Manager Registered Nurse in Glendale, CA. We'll work with you to build the healthcare career of your dreams. Whether you want a job close to home or across the country, we've...

Workers' Compensation Care Coordinator Carisk Partners, a Best Places to Work award winning organization, is a specialty risk transfer, care-coordination company servicing insurers, government entities, self-insured plan sponsors and...

About This Role The Palliative Care/Hospice Case Manager Utilization RN works collaboratively with physicians to coordinate patient admissions and discharges, ensuring appropriate care levels and resource use. This role is ideal for those...

Integra Partners seeks an experienced Utilization Management Nurse Supervisor to lead the UM nursing team, ensuring performance, accountability, and professional development. You will conduct regular 1:1s, manage performance reviews, and drive...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the...