Top 51 Utilization specialist full time Jobs in Santa Clara County Ca

Utilization Specialist - Full Time
San Jose Behavioral Health —San Jose, CA
- $33 - $50 an hour
- Full-time
- Acute care
- LMFT
- CPR Certification
12d
Program Manager, Demo Fleet & Test Drive Operations
Tesla —Fremont, CA
- $72,000 - $162,000 a year
- Extended hours
- 5 years
- SQL
- Analysis skills
- Commuter assistance
- Health savings account
HR Benefits Strategy Specialist - TikTok USDS-JV - San Jose
TikTok USDS JV —San Jose, CA
- $124,800 - $228,000 a year
- Hybrid work
- 5 years
- Office
- Fair chance
- Paid parental leave
- Paid holidays
Field Applications Specialist - West Region
BD —Milpitas, CA
- $95,600 - $153,000 a year
- Mid-level
- Driver's License
- Bachelor's degree
Outpatient Medical Biller
Bay Area Surgical Management LLC —Santa Clara, CA
- $28 - $30 an hour
- Full-time
- Background check
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Clinical Program Manager
First Place for Youth —San Jose, CA
- $109,163 - $116,000 a year
- Weekends as needed
- Hybrid work
- Background check
- LMFT
- Microsoft Excel
- Paid holidays
- Health insurance
Quick Apply
RN Case Manager
Santa Clara Family Health Plan —San Jose, CA
- $113,836 - $176,446 a year
- Full-time
- Clean driving record
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
Quick Apply
2d
AI Prompt Engineer & Workflow Specialist
Pacific Health Group —California
- $76,000 - $85,000 a year
- Full-time
- Hybrid work
- Google Workspace
- HIPAA
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
Registered Nurse - Clinical Case Consultant - ECM
Pacific Health Group —California
- $85,000 - $95,000 a year
- Weekends as needed
- Hybrid work
- Background check
- Spanish
- Nursing
- AD&D insurance
- Paid holidays
Quick Apply
Medical Field Case Manager
Enlyte —San Jose, CA
- $100,000 - $108,000 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Travel reimbursement
- Health savings account
Clinical Program Manager
First Place for Youth —San Jose, CA
- $109,163 - $116,000 a year
- Weekends as needed
- Hybrid work
- Background check
- LMFT
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
1d
Utilization Specialist - Full Time
The Camp Recovery Center —Scotts Valley, CA
- $25 - $27 an hour
- 8 hour shift
- CPR Certification
- Nursing
- RN License
- Health insurance
- Dental insurance
Head of Technical Talent Acquisition
Waymo —Mountain View, CA
- $285,000 - $352,000 a year
- Full-time
- Office
- Mentoring
- Senior level
Prenatal Account Executive
BillionToOne —Santa Clara, CA
- $136,869 - $248,269 a year
- Remote
- Hospital
- HIPAA
- Mid-level
- Paid parental leave
- Paid time off
Procurement Specialist -Bilingual Spanish
Samsung —Mountain View, CA
- $137,500 - $170,000 a year
- Full-time
- Spanish
- 5 years
- English
- Wellness program
- Health insurance
2d
Clinical Imaging R&D Specialist
DeepSight Technology —Santa Clara, CA
- $140,000 - $200,000 a year
- Full-time
- English
- Residential
- Pediatrics
- Health insurance
- Dental insurance
Quick Apply
Blind Rehabilitation Specialist (VIST Coordinator)
US Veterans Health Administration —Palo Alto, CA
- $133,810 - $173,957 a year
- Online Application
- Background check
- Writing skills
- Pass drug screening
5d
Program Manager Community Centers
Catholic Charities of Santa Clara County —San Jose, CA
- Weekends as needed
- Spanish
- Current TB test
- English
11d
Ergonomic Program Manager
PRN Physical Therapy —San Jose, CA
- $90,000 - $120,000 a year
- Full-time
- Hybrid work
- Background check
- 3 years
- Presentation skills
- Loan repayment program
- Health insurance
Quick Apply
2d
Category Manager
Stanford Health Care —Palo Alto, CA
- $62.75 - $83.16 an hour
- Full-time
- Hospital
- Inventory management
- 5 years
- Opportunities for advancement

I want to receive the latest job alert for utilization specialist full time in santa clara county 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 specialist full time jobs near santa clara county ca

Utilization Specialist - Full Time

San Jose Behavioral Health -
San Jose, CA

Apply Now

Job Details

Full-time
$33 - $50 an hour
12 days ago

Qualifications

CPR Certification
BLS Certification

Full Job Description

Overview:

Salary Range:LMFT/LPCC/LCSW $33.00 - $50.00 per hour - Based on Experience

Salary Range: LVN $33.00 - $43.75 per hour - Based on Experience

Salary Range: RN: $60.00 - per hour - Based on Experience

Location: ONSITE ONLY

San Jose Behavioral Health is currently seeking a Utilization Review Specialist - Full Time to assist the Utilization Department staff with comprehensive inpatient care and treatment within our 133-bed Acute Psychiatric Hospital. San Jose Behavioral Health is where adults and adolescents can receive comprehensive inpatient treatment for a range of behavioral and mental health disorders. Conveniently located in the heart of San Jose the hospital is easily accessible to residents in Santa Clara County, San Mateo County, and Alameda County.

PURPOSE STATEMENT:

The Utilization Review Specialist coordinates and assesses the inpatient census for appropriate alternate health care service needs. Responsibilities include performing on-site and/or telephonic concurrent review of acute and sub-acute services, as well as pre-certification review for all services following the plans authorization guidelines. Also, coordinate with appropriate discharge planning processes, providing feedback on documentation processes; and functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

Responsibilities:

ESSENTIAL FUNCTIONS:

Act as liaison between managed care organizations and the facility professional clinical staff.
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
Conduct quality reviews for medical necessity and services provided.
Facilitate peer review calls between facility and external organizations.
Initiate and complete the formal appeal process for denied admissions or continued stay.
Assist the admissions department with pre-certifications of care.
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.

Qualifications:

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

Associate Degree in Nursing(LPN/LVN/RN) Required.
Bachelors or Masters degree in Social Work, Behavioral Health Or Mental Health, Nursing or Other related health field preferred.

Two or more year's experience with the population of the facility preferred.
Previous experience in utilization management is preferred

LICENSES/DESIGNATIONS/CERTIFICATIONS:

LMFT, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.

ADDITIONAL REGULATORY REQUIREMENTS:

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

COMPENSATION

Compensation for roles at San Jose Behavioral Health varies depending on a wide array of factors including but not limited to the specific location, role, skill set, and level of experience. As required by local law, San Jose Behavioral Health provides a reasonable hourly range of compensation for roles that may be hired in California as set forth below.

Salary Range:LMFT/LPCC/LCSW $33.00 - $50.00 per hour - Based on Experience

Salary Range: LVN $33.00 - $43.75 per hour - Based on Experience

Salary Range: RN: $60.00 - per hour - Based on Experience

Location: ONSITE ONLY

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

SANJO

#LI-SJBH

Apply Now

Refine Your Search

utilization specialist full time jobs in santa clara county ca

Utilization Specialist - Full Time

Program Manager, Demo Fleet & Test Drive Operations

HR Benefits Strategy Specialist - TikTok USDS-JV - San Jose

Field Applications Specialist - West Region

Outpatient Medical Biller

Clinical Program Manager

RN Case Manager

AI Prompt Engineer & Workflow Specialist

Registered Nurse - Clinical Case Consultant - ECM

Medical Field Case Manager

Clinical Program Manager

Utilization Specialist - Full Time

Head of Technical Talent Acquisition

Prenatal Account Executive

Procurement Specialist -Bilingual Spanish

Clinical Imaging R&D Specialist

Blind Rehabilitation Specialist (VIST Coordinator)

Program Manager Community Centers

Ergonomic Program Manager

Category Manager

I want to receive the latest job alert for utilization specialist full time in santa clara county ca

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected