Top 36 Utilization review nurse Jobs in Rancho Cordova 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
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
Care Coordinator RN
Methodist Hospital Sacramento —Sacramento, CA
- $98.49 an hour
- PRN
- Acute care
- Nursing
- RN License
Care Manager, Registered Nurse
Sutter Health —Roseville, CA
- $82.48 - $115.46 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
Patient Logistics Clinical Coordinator RN-CA
Dignity Health —Rancho Cordova, CA
- $52.15 - $77.58 an hour
- Full-time
- 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
MDS Coordinator
Double Tree Post Acute —Sacramento, CA
- From $46.53 an hour
- Full-time
- Anatomy knowledge
- Skilled nursing facility
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
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
Care Manager, Registered Nurse, Emergency Department
Sutter Health —Roseville, CA
- $82.48 - $115.46 an hour
- Weekends as needed
- Nursing
- RN License
- Customer service
4d
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
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
10d
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
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
11d
Home Health Registered Nurse
Primetime Home Health Agency —Sacramento, CA
- $50 - $150 an hour
- Part-time
- Nursing
- Vital signs
- RN License
Quick Apply
13d
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
11d
CA Medical Case Mgr III
CorVel Corporation —Folsom, CA
- $35.26 - $54.45 an hour
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
14d
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
Case Manager LVN Full Time
McKinley Park Care Center —Sacramento, CA
- Full-time
- Nursing
- LVN
- RN License
Quick Apply
6d
Primary Care Provider, Nurse Practitioner / Physician Assistant
WelbeHealth —Elk Grove, CA
- $150,009.60 - $190,207.44 a year
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply

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utilization review nurse jobs near rancho cordova 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 rancho cordova ca

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

Utilization Management Nurse, Senior

Care Coordinator RN

Care Manager, Registered Nurse

Patient Logistics Clinical Coordinator RN-CA

Clinical Review Specialist (Roseville)

MDS Coordinator

Case Manager - Ambulatory - 26-43

Care Manager, Registered Nurse, Emergency Department

RN Case Manager Full Time

Utilization Management Nurse (RN) (Temporary)

Registered Nurse

CA Telephonic Case Manager I

Case Manager (LPN/LVN License Required)

Home Health Registered Nurse

Case Manager - Ambulatory - 26-94

CA Medical Case Mgr III

CA Medical Case Manager I

Case Manager LVN Full Time

Primary Care Provider, Nurse Practitioner / Physician Assistant

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