Top 49 Rn utilization review Jobs in Folsom, Ca

Case Manager - Ambulatory - 26-43
PriMed Management Consulting Services, Inc. —Sacramento, CA
- $100,000 - $123,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- RN License
Quick Apply
Utilization Management Nurse, Senior
Blue Shield of California —El Dorado Hills, CA
- $90,860 - $136,290 a year
- Weekends as needed
- Hybrid work
- Background check
- Nursing
- RN License
- Work from home
Manager, Utilization Management Nurse Management
Blue Shield of California —El Dorado Hills, CA
- $111,540 - $167,420 a year
- Full-time
- Hybrid work
- Background check
- Nursing
- RN License
- Work from home
Manager, Behavioral Health Utilization Management
Blue Shield of California —El Dorado Hills, CA
- $111,540 - $167,420 a year
- Full-time
- Hybrid work
- Background check
- LMFT
- Nursing
- Work from home
Manager, Case Management Nurse Management- Population Health Management
Blue Shield of California —Rancho Cordova, CA
- $111,540 - $167,420 a year
- Full-time
- Hybrid work
- Background check
- Nursing
- RN License
- Work from home
Care Manager, Registered Nurse
Sutter Health —Roseville, CA
- $82.48 - $115.46 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —Sacramento, CA
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
RN, Health Plan Care Manager
Adventist Health —Roseville, CA
- $45.39 - $62.26 an hour
- Nursing
- RN License
- Inpatient
CA Telephonic Case Manager I
CorVel Corporation —Folsom, CA
- $30.64 - $45.80 an hour
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
Manager, Healthcare Services - Remote (Must Reside in California)
Molina Healthcare —Sacramento, CA
- $84,067 - $163,931 a year
- Full-time
- LMFT
- Nursing
- Microsoft Excel
- Health insurance
Registered Nurse
Caring Hand Home Health Solutions, Inc. —El Dorado Hills, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Authorization Nurse, RN - Hybrid (Remote Considered) - 26-88
PriMed Management Consulting Services, Inc. —Sacramento, CA
- $100,000 - $123,000 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- LVN
Quick Apply
10d
Authorization Nurse, RN - 26-71
PriMed Management Consulting Services, Inc. —Sacramento, CA
- $100,000 - $123,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- LVN
Quick Apply
Registered Nurse
Premier Home Health Providers Inc. —El Dorado Hills, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Carmichael, CA
- $3,246 a week
- 8 hour shift
- Acute care
- Nursing
- RN License
Quick Apply
RN Case Manager Full Time
Vibra Healthcare —Folsom, CA
- $60.00 - $84.60 an hour
- Full-time
- Nursing
- RN License
- BLS Certification
- Continuing education credits
- Health savings account
11d
Supervisor, Health Plan Clinical Operations, RN
Sutter Health —Sacramento, CA
- $198,556.80 - $277,971.20 a year
- Weekends as needed
- Master of Social Work
- Nursing
- RN License
9d
Appeals & Grievances Nurse
Western Health Advantage —Sacramento, CA
- $95,000 - $115,000 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
Quick Apply
Authorization Nurse, RN - 26-66
PriMed Management Consulting Services, Inc. —Sacramento, CA
- $100,000 - $123,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- RN License
Quick Apply
4d
CA Medical Case Manager I
CorVel Corporation —Folsom, CA
- $30.64 - $45.80 an hour
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply

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rn utilization review jobs near folsom, ca

Case Manager - Ambulatory - 26-43

PriMed Management Consulting Services, Inc. -
Sacramento, CA

Quick Apply

Job Details

Full-time
$100,000 - $123,000 a year

Qualifications

Collaborate with healthcare professionals
Computer operation
Microsoft Outlook
Medicare
RN License
Managed care organization experience
Computer literacy
ICD-10
Documentation tools
Video conferencing software
Telehealth platforms
Collaborative technology platforms
Microsoft Teams
Video conferences (communication methods)
Clinical documentation standards
Associate's degree
Associate Degree in Nursing
Video conferencing systems operation

Full Job Description

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

The RN Case Manager provides telephonic and digital case management services to health plan members, focusing on supporting patients after emergency department visits or hospitalizations to ensure smooth transitions and prevent readmissions. Case management is a collaborative, patient-centered process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet health and human service needs. The role emphasizes advocacy, communication, care coordination, and resource management to promote high-quality, cost-effective outcomes. This position operates in a fully virtual environment, requiring proficiency with telephonic platforms, electronic documentation, and multi-system navigation.

ESSENTIAL RESPONSIBILITIES:

Core Case Management Activities

Identify members appropriate for case management based on clinical indicators, referrals, utilization patterns, and health-related concerns.
Conduct comprehensive assessments of members’ physical, psychosocial, behavioral, and environmental needs and barriers.
Develop individualized care plans aligned with member goals, provider recommendations, and established standards of practice.
Implement and coordinate interventions to address barriers, enhance access, and support successful goal achievement in collaboration with physicians, caregivers, and other providers.
Document assessments, interventions, care plans, progress notes, and member interactions within the case management system according to policy and regulatory criteria.

Ambulatory Case Management Responsibilities

Provide structured case management services for ambulatory and outpatient populations, including those with chronic or complex conditions.
Conduct proactive outreach to members identified through data analytics, referrals, or quality measures to support early engagement and intervention.
Coordinate care across primary care, specialty care, behavioral health, pharmacy, and community resources to ensure cohesive outpatient support.
Facilitate timely follow-up after emergency department visits, urgent care visits, or hospital discharges to ensure continuity of care.
Reinforce treatment plans, promote medication adherence, and support self-management for chronic disease populations (e.g., diabetes, COPD, CHF).
Monitor member progress and adjust care plans based on evolving needs and medical provider feedback.
Identify and address social determinants of health, connecting members with community-based support and resources.
Track ambulatory utilization and collaborating with internal teams to reduce avoidable ER use and close care gaps.

Additional Responsibilities

Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory, and accreditation standards.
Ensure compliance with department procedures, turnaround times, and documentation standards.
Support interdisciplinary care processes to promote optimal resource utilization and quality outcomes.
Maintain and update community resource databases and internal referral pathways.
Utilize reporting tools and internal systems to identify trends, monitor resource utilization, and support quality improvement initiatives.
Refer members to appropriate departments such as Health Education, Quality Management, Contracting, Provider Services, and others as needed.
Issue member communications in accordance with department policies.
Support the Medical Management Team, including Authorization Review, Clinical Initiatives, and Provider Education functions.
Participate in internal and external meetings, training, and educational programs to maintain and enhance case management competencies.
Perform other duties as assigned.

Required Experience

Minimum 5 years of experience required, including:
- At least 3 years of clinical nursing experience in areas such as medical-surgical, critical care, home health, or skilled nursing.
- At least 2 years of experience in case management, utilization management, discharge planning, or quality improvement in a managed care setting.
Experience with managed care delivery, including IPA networks and Medicare.
Strong organizational skills with ability to meet both expected and unexpected time frames.
Excellent verbal and written communication skills.
Proficiency in Microsoft Outlook, Teams, and electronic charting systems.
Ability to navigate multiple platforms and document while engaging with members.
Ability to coordinate effectively with members, providers, office staff, health plans, internal departments, community resources, and peers.
Ability to work independently with self-initiative and discipline.
Knowledge of ICD-10 and CPT coding.
Working knowledge of personal computers.

Hybrid/Remote Work Requirements

Dedicated office space that is free from distractions, with a door that closes and appropriate office furniture.
Staff cannot be the primary caregiver to any person during business hours.
High-speed internet connection.
Ability to be on camera during department meetings or calls with peers or leaders.

Required Education

Associate degree in Nursing (A.S.) required.
Unrestricted California Registered Nurse licensure: certification in case management preferred

Additional Information

Salary: $100,000 - $123,000 Annual

Hill Physicians is an Equal Opportunity Employer

Quick Apply

Refine Your Search

rn utilization review jobs in folsom, ca

Case Manager - Ambulatory - 26-43

Utilization Management Nurse, Senior

Manager, Utilization Management Nurse Management

Manager, Behavioral Health Utilization Management

Manager, Case Management Nurse Management- Population Health Management

Care Manager, Registered Nurse

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

RN, Health Plan Care Manager

CA Telephonic Case Manager I

Manager, Healthcare Services - Remote (Must Reside in California)

Registered Nurse

Authorization Nurse, RN - Hybrid (Remote Considered) - 26-88

Authorization Nurse, RN - 26-71

Registered Nurse

Travel RN - Case Management/Utilization Review - Case Management

RN Case Manager Full Time

Supervisor, Health Plan Clinical Operations, RN

Appeals & Grievances Nurse

Authorization Nurse, RN - 26-66

CA Medical Case Manager I

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