Top 32 Utilization management Jobs in Twentynine Palms, Ca

UM Licensed Vocational Nurse (REMOTE)
Medica Talent Group —California
- $33 - $46 an hour
- Temporary
- Remote
- Microsoft Excel
- Microsoft Outlook
- LVN
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Case Manager
Hi-Desert Medical Center —Joshua Tree, CA
- Full-time
- Master of Social Work
- Hospital
- Computer literacy
- Health savings account
- Health insurance
Business Office Manager
Rockwell Care —Yucca Valley, CA
- $85,000 - $95,000 a year
- Full-time
- Skilled nursing facility
- Mid-level
- Residential
- Health insurance
- Dental insurance
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Licensed Social Worker (LCSW)
Hi-Desert Medical Center —Joshua Tree, CA
- Full-time
- Hospital
- Computer literacy
- Licensed Clinical Social Worker
- Health savings account
- Health insurance
Virtual Nurse Practitioner or Physician Assistant- CA License
One Medical —Twentynine Palms, CA
- $59.10 - $65.50 an hour
- Weekends as needed
- Remote
- Mid-level
- Outpatient experience
- Master's degree
- Commuter assistance
- Paid parental leave
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Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
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Case Manager
Hi-Desert Medical Center —Joshua Tree, CA
This individual’s responsibility will include the following activities: a) complex psycho-social transition planning assessment and reassessment and…
Psychiatrist
Beloved Ones —California
Valid state medical license as MD or DO. Develops treatment plans by determining nature and extent of cognitive, emotional, developmental, social, and…
$200,000 - $250,000 a year
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Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
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UR Coordinator, Full Time
RiverVista Behavioral Hospital —Columbus, OH
High school diploma required; associate or bachelor’s degree in nursing, healthcare administration, or related field preferred. Must be 21 or older.
$24 - $32 an hour
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utilization management jobs near twentynine palms, ca

UM Licensed Vocational Nurse (REMOTE)

Medica Talent Group
California

Quick Apply

Job Details

Temporary | Full-time
$33 - $46 an hour

Qualifications

Customer communication
Microsoft Excel
Microsoft Outlook
Medicare
LVN
Managed care
Electronic health records (EHR) management
Customer service
Managed care organization experience
CMS
Regulatory compliance
Word embeddings
HIPAA
Microsoft Office
CMS regulatory compliance
Pre-authorization review for utilization management
Medicare regulations
Utilization management
Clinical program data analysis
Conflict management
Clinical documentation
Resource utilization in healthcare
Health information regulatory compliance
Medicaid regulations
Clinical confidentiality policies
Clinical data analysis

Full Job Description

The LVN Utilization Management Nurse is responsible for reviewing and processing authorization requests to ensure services are medically necessary, appropriate, timely, and consistent with health plan benefits, regulatory requirements, and nationally recognized clinical guidelines. This position reviews inpatient and outpatient services, hospitalizations, home care, treatment plans, and ongoing services while supporting cost-effective, high-quality patient care.

The UM Nurse works closely with Medical Directors, Hospitalists, providers, health plans, hospital partners, and care teams to facilitate timely authorization decisions and coordinate patient care. Responsibilities include verifying member eligibility and benefits, conducting concurrent and retrospective reviews, processing referrals and prior authorizations, coordinating discharge planning, and communicating authorization decisions to providers and members.

The position requires strong knowledge of utilization management processes, Medicare, Medi-Cal, Commercial, CCS, and other government program requirements, as well as familiarity with evidence-based criteria such as Milliman, InterQual, CMS, and specialty-specific guidelines. The UM Nurse must maintain accurate documentation, meet required turnaround times, protect patient confidentiality, and comply with HIPAA and applicable federal and state regulations.

Minimum Qualifications:

Current, valid Licensed Vocational Nurse (LVN) license.
Minimum of 2 years of managed care experience.
Experience using electronic medical records, authorization systems, and Microsoft Office applications, including Word, Excel, and Outlook.
Knowledge of utilization management, pre-authorizations, reimbursement regulations, and applicable federal and state requirements.
Strong communication, customer service, interpersonal, problem-solving, and conflict-resolution skills.
Ability to work collaboratively with diverse internal and external stakeholders.
Strong attention to detail and ability to analyze and interpret clinical and operational data.
Knowledge of DOFRs, delegation agreements, authorization matrices, and health plan requirements preferred.
Commitment to HIPAA compliance, privacy, and confidentiality standards.

Key Responsibilities:

Review and process referral and authorization requests within established turnaround time requirements.
Evaluate medical necessity and level of care using applicable clinical and evidence-based guidelines.
Verify member eligibility and benefits and communicate authorization decisions to providers and members.
Monitor ongoing services for medical necessity, appropriateness, and cost effectiveness.
Coordinate with Medical Directors, referral specialists, providers, hospitals, and health plans to facilitate timely decisions.
Process and coordinate Letters of Agreement (LOAs) for non-contracted providers and facilities, when applicable.
Conduct concurrent and retrospective reviews, discharge planning, and prior authorization/pre-certification activities as assigned.
Maintain accurate and timely documentation in the Medical Management system.
Stay current on utilization management regulations, health plan requirements, and applicable clinical guidelines.
Develop positive working relationships with internal and external customers while supporting high-quality, cost-effective patient care.

***TEMP POSITION - ASSIGNMENT ENDS 10/31/26***

Pay: $33.00 - $46.00 per hour

Experience:

Managed care: 2 years (Required)
Microsoft Office: 1 year (Required)

License/Certification:

LVN (Required)

Location:

California (Required)

Work Location: Remote

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utilization management jobs in twentynine palms, ca

UM Licensed Vocational Nurse (REMOTE)

Case Manager

Business Office Manager

Licensed Social Worker (LCSW)

Virtual Nurse Practitioner or Physician Assistant- CA License

Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)

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