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Utilization Management jobs in California

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SUPERVISOR, UTILIZATION MANAGEMENT

Supervises and coordinates activities of utilization review staff in maintenance of informed policy and procedure manuals, files, records and correspondence. Provide guidance on issues related to referral and authorization process...

CompanyAltais
AddressOakland, CA
CategoryHuman Resources
Job typeFull-Time
Date Posted 3 hours ago See detail

Supervisor, Utilization Management New

Altais

Oakland, CA

Supervises and coordinates activities of utilization review staff in maintenance of informed policy and procedure manuals, files, records and correspondence. Provide guidance on issues related to referral and authorization process...

3 hours ago seen See more...

Director Utilization Management New

Commonspirit Health

Rancho Cordova, CA

Current California RN license. Bachelor's degree in Nursing, Health Care Administration or advanced clinical degree. Minimum of three (3) years clinical case management (Utilization Management, denial management, care coordination...

4 hours ago seen See more...

Utilization Management Coordinator New

Yoh, A Day & Zimmermann Company

Alameda, CA

One (1) year of Managed Care experience (HMO or IPA) strongly preferred. Ability to work from home M-F, 8am-5pm PT. Support clinical staff through completion of the administrative and nonclinical coordinator functional components...

3 hours ago seen See more...

RN Supervisor Utilization Management New

Dignity Health Medical Foundation

Rancho Cordova, CA

Under general supervision this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory g...

3 hours ago seen See more...

Customer Success Utilization Manager - MN/WI

Karl Storz Endoscopy - America

Los Angeles, CA

$67,600 - $107,800 per year

Consult with customers to create a customized strategy that ensures customers understand, utilize, and leverage products purchased and bringing to life the VALUE of their installation. Custom design, plan and execute on plans for...

a week ago seen See more...

Director - Utilization Management

San Jose Behavioral Health

San Jose, CA

Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs. . Conducts and oversees concurrent and retrospective reviews for all patients....

2 weeks ago seen See more...

Case Manager Utilization RN, 32/hr Day

Kaiser Permanente

Los Angeles, CA

Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...

4 days ago seen See more...

Case Management Utilization RN, 20/hr Day

Kaiser Permanente

San Diego, CA

Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...

4 days ago seen See more...

Utilization Management Representative II

Elevance Health

PALO ALTO, CA

Managing incoming calls or incoming post services claims work. . Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requ...

3 weeks ago seen See more...

RN Supervisor Utilization Management

Commonspirit Health

Rancho Cordova, CA

Under general supervision this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory g...

3 weeks ago seen See more...

Care Review Processor with Utilization Review/Managed Care Exp. (REMOTE - CA)

Omg Technology

Long Beach, CA

Provide computer entries of authorization requests/provider inquiries by phone, mail, or fax. Including: Verify member eligibility and benefits. Determine provider contracting status and appropriateness. Determine diagnosis and tr...

4 weeks ago seen See more...

Utilization Management Nurse Consultant

Cvs Health

Sacramento, CA

$29.50 - $63.75 an hour

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical informati...

4 weeks ago seen See more...

Utilization Management Coordinator

Astrana Health

Monterey Park, CA

Comply with UM policies and procedures. Annual review of selected UM policies. Read and understand NMM UM Customer Service Policy and Procedures. Answer incoming calls from providers both contracted and non-contracted. (Average 60...

a month ago seen See more...

Remote Utilization Management (UM) Coordinator (Long-Term Temporary w/ Medical Benefits)

Alignment Healthcare

Lake Forest, CA

Pacific Time: 8am - 5pm. Mountain Time: 9am - 6pm. Central Time: 10am - 7pm. Eastern Time: 11am - 8pm. Monitor fax folders. Verify eligibility and / or benefit coverage for requested services. Enter pre-service requests / authoriz...

a month ago seen See more...

Utilization Management Denial Review Nurse - LVN

Ucla Health

Los Angeles, CA

$61,400 - $121,400 a year

DescriptionQualificationsWere seeking an exceptionally gifted, self-motivated leader with: * Current CA LVN licensure required * Two or more years of utilization review/Utilization Management experience in an HMO, MSO, IPA, or he...

a month ago seen See more...

Utilization Management Supervisor (Dental Insurance)

Liberty Dental Plan

Tustin, CA

$58,760 - $76,388 a year

Assist with recruiting, hiring, evaluation, and selection. Update job descriptions and develop performance expectations. Supervise employee and team performance. Train and provide adequate coaching, counseling, and motivation; ide...

a month ago seen See more...

Case Manager Utilization RN-Per Diem

Kaiser Permanente

Ventura, CA

Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...

2 weeks ago seen See more...

Senior Utilization Management Assistant

Providence

Anaheim, CA

$22.93 - $35.77 an hour

Associate's Degree in Health care, business or related field, preferred or. Bachelors Degree in Health care, business or related field, preferred or equivalent education/experience....

a month ago seen See more...

Utilization Management Supervisor

Hill Physicians Medical Group

San Ramon, CA

$110,000 - $120,000 a year

Provide clinical expertise, guidance and supervision to the Authorizations staff including clinical and non-clinical staff. Lead by example and act as a resource to staff by resolving clinical and benefit issues. Manage staff prod...

a month ago seen See more...

Utilization Management Nurse Specialist, FT Days

Pih Health

Whittier, CA

Current knowledge of Managed Care and Health Plan Division of Financial Responsibilities (DOFR). Ability to apply appropriate UM criteria. Excellent communication skills. Strong organizational capabilities. Attention to detail is...

a month ago seen See more...

Remote Inpatient Utilization Management (UM) Coordinator

Alignment Healthcare

Stanton, CA

Assist team with daily census by entering face sheets for hospitals and skilled nursing facilities (SNF). Obtain medical records from hospitals and SNF's. Attach medical records to authorizations. Enter referral requests / authori...

a month ago seen See more...

Registered Nurse - Utilization Management - 8 Hour Days

Cedars-Sinai

Los Angeles, CA

$52.47 - $83.95 an hour

The UR Case Manager uses medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures an...

2 months ago seen See more...

RN - Utilization Management

Spectrum Healthcare Resources

Los Angeles, CA

Degree/Education: Bachelor of Science in Nursing. Graduate from a college or university accredited by National League for Nursing Accrediting Commission (NLNAC), or The Commission on Collegiate Nursing Education (CCNE). Experience...

2 months ago seen See more...

Utilization Management Supervisor

Ucla Health

Los Angeles, CA

$61,400 - $121,400 a year

DescriptionQualificationsWere seeking a self-motivated, team-focused, deadline-driven, detail-oriented leader with: * High school diploma, GED or equivalent required * Two or more years of experience managing staff in a healthcar...

2 months ago seen See more...

Denial Review Nurse - Utilization Management - Hybrid

Astrana Health

Monterey Park, CA

$30 - $45 an hour

Responsible for managing all deferrals and or denials by conducting a comprehensive review of clinical documentation, clinical criteria/guideline, policy, and or EOC/benefit policy Apply clinical knowledge when processing all defe...

2 months ago seen See more...

Utilization Management Assistant - Utilization Management

Providence

Hesperia, CA

$20.64 - $31.52 an hour

1 year Experience in a hospital, health insurance company or medical office/clinic setting. Coursework/Training: College level classes, preferably in healthcare or related field. Associate's Degree in Healthcare or related field....

2 months ago seen See more...

Utilization Management LVN

Welbehealth

Los Angeles, CA

Chart audits of items including but not limited to consult summaries, imaging results, and procedure summaries to determine if additional follow up services are requested. Oversee departmental clinical inboxes, email inboxes, and...

2 months ago seen See more...

Case Management Utilization RN PD Day

Kaiser Permanente

Harbor City, CA

Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...

2 weeks ago seen See more...

Case Manager Utilization RN, 32/hr Day

Kaiser Permanente

Panorama City, CA

Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...

3 weeks ago seen See more...

Utilization Review-Case Management (Full-Time)

Aurora San Diego

San Diego, CA

$66,560 - $124,800 a year

Pay Range: $32/hr. to $60/hr. Admissions: Conduct admission reviews. Concurrent/Stay Reviews: Conduct concurrent and extended stay reviews. Payment Appeals: Prepare and submit appeals to third party payers. Recordkeeping: Maintain...

3 weeks ago seen See more...

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What companies are hiring for Utilization Management jobs in California?

The top companies hiring now for Utilization Management jobs are All's Well, Alura Workforce Solutions, Ampcus, CalOptima, CommonSpirit Health, CVS Health, Dignity Health Management Services, Elevance Health, Healthcare Support, Impresiv Health, Inland Empire Health Plan, KHS, LHH Recruitment Solutions, Optum, Optum - 3.3,

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