Top 25 Utilization review nurse Jobs in Aliso Viejo Ca

Utilization Management Nurse I, RN
Clever Care Health Plan —Huntington Beach, CA
- $34.98 - $42.85 an hour
- Full-time
- Remote
- Background check
- Spanish
- RN License
CLINICAL DOCUMENTATION SPECIALIST 4 HX - Clinical Doc Integrity - FT Days HYBRID
University of California, Irvine —Orange, CA
- $119,400 - $230,800 a year
- Weekends as needed
- Remote
- Background check
- Nursing
- Customer service
- Health insurance
- Retirement plan
Utilization Review LPN LVN
Providence —Anaheim, CA
- $40.89 - $63.48 an hour
- Part-time
- Nursing
- LVN
- Medical office experience
- Paid parental leave
- Paid holidays
10d
LVN MDS Coordinator
Garden Park Care Center —Garden Grove, CA
- $40 - $45 an hour
- Full-time
- Skilled nursing facility
- Medication administration
- LVN
- Health insurance
- Dental insurance
Quick Apply
11d
Hospice Case Manager
COMMUNITY CARE HOSPICE —Dana Point, CA
- $55 - $250 an hour
- Part-time
- HIPAA
- Inpatient
- Mid-level
- Health insurance
- Paid time off
Quick Apply
Clinical Documentation Integrity (CDI) Review
CareConnectMD Inc —Costa Mesa, CA
- Full-time
- Microsoft Outlook
- HIPAA
- Quality control
Quick Apply
9d
Case Manager - Sub-Acute
Foothill Regional Medical Center —Tustin, CA
- $34.40 - $48.40 an hour
- Email
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Utilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)
Alignment Healthcare USA, LLC —Orange, CA
- $85,696 - $128,543 a year
- Full-time
- Remote
- Nursing
- LVN
- RN License
Quick Apply
Care Manager I (RN) - PD : Irvine Care Management
Hoag Health System —Irvine, CA
- Full-time
- Nursing
- RN License
- Mid-level
2d
Inpatient Nurse Case Manager
ECHO —Newport Beach, CA
- $33.50 - $45.00 an hour
- Full-time
- Microsoft Word
- Master of Social Work
- Nursing
Quick Apply
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Mission Viejo, CA
- $2,510.11 a week
- Rotating weekends
- Acute care
- RN License
- Hospital
Quick Apply
Case Manager - Utilization Management
West Anaheim Medical Center —Anaheim, CA
- $30.28 - $43.32 an hour
- Full-time
- Acute care
- Hospital
- Computer literacy
- Health insurance
- Dental insurance
Care Manager
CareConnect Health Services Inc —Costa Mesa, CA
- Full-time
- Microsoft Excel
- Skilled nursing facility
- LVN
- COVID-19 protective measures
Quick Apply
Home Health Registered Nurse
Best Match Home Health —Orange County, CA
- $150 an hour
- Part-time
- HIPAA
- Mid-level
- Outpatient experience
Quick Apply
Team Manager Inpatient
VITAS Healthcare —Irvine, CA
- Full-time
- RN License
- Bachelor's degree
- Recruiting
- Disability insurance
- Health insurance
Quick Apply
4d
Medical Field Case Manager
Enlyte —Lake Elsinore, CA
- $95,000 - $98,000 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Travel reimbursement
- Health savings account
20h
LVN Lead Care Manager
Sowing Seeds Health Inc —Irvine, CA
- $35 an hour
- Full-time
- LVN
- Mid-level
- In-person
- Mileage reimbursement
- Paid holidays
Quick Apply
RN Case Manager (PD-Days)
KPC GLOBAL MEDICAL CENTERS INC. —Santa Ana, CA
- $42.89 - $64.33 an hour
- Full-time
- Acute care
- RN License
- Computer literacy
- AD&D insurance
- Health insurance
Quick Apply
RN ER Case Manager - FT- 8hrs (Days)
KPC GLOBAL MEDICAL CENTERS INC. —Santa Ana, CA
- $42.89 - $64.33 an hour
- Full-time
- RN License
- Computer literacy
- BLS Certification
- AD&D insurance
- Health insurance
Quick Apply
Nurse Practitioner
CareConnectMD Inc —Costa Mesa, CA
- $140,000 - $145,000 a year
- Weekends as needed
- CPR Certification
- Nursing
- Skilled nursing facility
Quick Apply

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

Utilization Management Nurse I, RN

Clever Care Health Plan -
Huntington Beach, CA

Apply Now

Job Details

Full-time
$34.98 - $42.85 an hour

Qualifications

RN License
Patient care

Full Job Description

Remote in California only

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We? ✨

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.

Why Join Us?

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Job Summary

The UM Nurse I - RN performs clinical review of authorization requests to determine medical necessity based on established criteria, regulatory requirements, and organizational policies. This role conducts utilization review activities under established guidelines and escalates complex or non-standard determinations to senior staff or the Medical Director.

Functions & Job Responsibilities

Conduct clinical review of prior authorization requests using approved criteria (e.g., MCG, InterQual).
Review outpatient and routine inpatient requests.
Ensure compliance with CMS, state, and contractual turnaround time requirements.
Document medical necessity determinations clearly and accurately.
Communicate authorization decisions to providers, members and internal teams.
Identify cases requiring physician or Medical Director review.
Participate in concurrent review and discharge planning coordination as assigned.
Ensure compliance with regulatory timelines.
Support audit readiness and documentation integrity.
Additional duties as assigned.

Qualifications

Education and Experience

Active, unrestricted RN license.
Minimum of three (3) years of clinical experience.
At least one (1) year in utilization management or case management preferred.

Skills

Knowledge of medical necessity criteria (MCG/InterQual).
Understanding of CMS/state UM regulations.
Strong clinical assessment and documentation skills
Ability to manage caseload efficiently.
Effective provider communication.
Bilingual proficiency in Cantonese, Mandarin, Spanish, Vietnamese, or Korean preferred.

Wage Range: $34.98 to $42.85 per hour

Physical & Working Environment.

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

Must be able to travel when needed or required
Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.

#LI-Remote

Apply Now

Refine Your Search

utilization review nurse jobs in aliso viejo ca

Utilization Management Nurse I, RN

CLINICAL DOCUMENTATION SPECIALIST 4 HX - Clinical Doc Integrity - FT Days HYBRID

Utilization Review LPN LVN

LVN MDS Coordinator

Hospice Case Manager

Clinical Documentation Integrity (CDI) Review

Case Manager - Sub-Acute

Utilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)

Care Manager I (RN) - PD : Irvine Care Management

Inpatient Nurse Case Manager

Travel RN - Case Management/Utilization Review - Case Management

Case Manager - Utilization Management

Care Manager

Home Health Registered Nurse

Team Manager Inpatient

Medical Field Case Manager

LVN Lead Care Manager

RN Case Manager (PD-Days)

RN ER Case Manager - FT- 8hrs (Days)

Nurse Practitioner

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

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected