Top 39 Utilization review nurse Jobs in Folsom Ca

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
Health Care Professional – Utilization Review / First-Level Reviewer
Encompass Health Solutions, Inc. —Sacramento, CA
- $42 - $45 an hour
- Overtime
- Remote
- LVN
- RN License
- Mid-level
Quick Apply
4d
Medical Reviewer (Registered Nurse) - Remote CA
Gainwell Technologies —West Sacramento, CA
- $70,000 - $100,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Travel reimbursement
- Profit sharing
1d
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
Patient Logistics Clinical Coordinator RN-CA
Dignity Health —Rancho Cordova, CA
- $52.15 - $77.58 an hour
- Full-time
- Acute care
- Nursing
- RN License
Medical Reviewer (Physical Therapist) - Remote CA
Gainwell Technologies —West Sacramento, CA
- $85,000 - $100,000 a year
- Full-time
- Remote
- Physical & Rehabilitation Medicine
- Mid-level
- 3 years
- Travel reimbursement
- Profit sharing
1d
Clinical Coding Analyst RN, Consultant
Blue Shield of California —El Dorado Hills, CA
- $111,540 - $167,420 a year
- Full-time
- Hybrid work
- Background check
- Nursing
- Oracle
- Work from home
4d
Care Manager, Registered Nurse
Sutter Health —Roseville, CA
- $82.48 - $115.46 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
Clinical Review Specialist (Roseville)
Adventist Health —Roseville, CA
- $81,273 - $121,909 a year
- Day shift
- Nursing
- RN License
- Mid-level
Care Manager, Registered Nurse, Emergency Department
Sutter Health —Roseville, CA
- $82.48 - $115.46 an hour
- Weekends as needed
- Nursing
- RN License
- Customer service
10d
Utilization Management Nurse (RN) (Temporary)
Central California Alliance for Health —Sacramento, CA
- $49.00 - $57.50 an hour
- Temporary
- Hybrid work
- Nursing
- RN License
- Mid-level
- Wellness program
- Paid holidays
Quick Apply
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
Medical Reviewer (Speech and Audiology Specialist) - Remote CA
Gainwell Technologies —West Sacramento, CA
- $80,000 - $100,000 a year
- Full-time
- Remote
- Mid-level
- 3 years
- Computer skills
- Travel reimbursement
- Profit sharing
1d
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
Case Manager (LPN/LVN License Required)
Citrus Heights Post Acute —Citrus Heights, CA
- $40 - $47 an hour
- Weekends as needed
- Nursing
- LVN
- RN License
Quick Apply
Primary Care Provider, Nurse Practitioner / Physician Assistant
Welbehealth —Elk Grove, CA
- $150,009.60 - $190,207.44 a year
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply
Nurse Practitioner/Physician Assistant
FOWAD Advanced Nursing Services Inc —California
- $85 - $150 an hour
- Per diem
- Vital signs
- Mid-level
- Outpatient experience
- Flexible schedule
Quick Apply
Medical Reviewer (Podiatrist) - Remote CA
Gainwell Technologies —West Sacramento, CA
- $110,000 - $130,000 a year
- Full-time
- Remote
- Doctoral degree
- Mid-level
- Computer skills
- Travel reimbursement
- Profit sharing
1d
Case Manager LVN Full Time
McKinley Park Care Center —Sacramento, CA
- Full-time
- Nursing
- LVN
- RN License
Quick Apply
12d
Case Manager - Ambulatory - 26-94
PriMed Management Consulting Services, Inc. —Sacramento, CA
- $100,000 - $123,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- RN License
Quick Apply

I want to receive the latest job alert for utilization review nurse in folsom ca

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review nurse jobs near folsom ca

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

Molina Healthcare -
Sacramento, CA

Apply Now

Job Details

Full-time
$30.37 - $59.21 an hour

Benefits

Health insurance

Qualifications

Inpatient experience
RN License
Managed care organization experience
Pre-authorization review for utilization management
Acute care experience
Productivity software
Nursing

Full Job Description

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 regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.

Required Qualifications

At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications
Certified Professional in Healthcare Management (CPHM).

Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

utilization review nurse jobs in folsom ca

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

Health Care Professional – Utilization Review / First-Level Reviewer

Medical Reviewer (Registered Nurse) - Remote CA

RN Case Manager Full Time

Patient Logistics Clinical Coordinator RN-CA

Medical Reviewer (Physical Therapist) - Remote CA

Clinical Coding Analyst RN, Consultant

Care Manager, Registered Nurse

Clinical Review Specialist (Roseville)

Care Manager, Registered Nurse, Emergency Department

Utilization Management Nurse (RN) (Temporary)

Registered Nurse

Medical Reviewer (Speech and Audiology Specialist) - Remote CA

CA Telephonic Case Manager I

Case Manager (LPN/LVN License Required)

Primary Care Provider, Nurse Practitioner / Physician Assistant

Nurse Practitioner/Physician Assistant

Medical Reviewer (Podiatrist) - Remote CA

Case Manager LVN Full Time

Case Manager - Ambulatory - 26-94

I want to receive the latest job alert for utilization review nurse in folsom ca

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected