Top 2744 Nurse clinician Jobs in California

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —California
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
Clinical Appeals Nurse (Remote | Must have California LVN / RN License)
Alignment Healthcare USA, LLC —Orange, CA
- $77,905 - $116,858 a year
- Full-time
- Remote
- Microsoft Word
- Spanish
- Nursing
Quick Apply
Risk Adjustment Registered Nurse
CareLinx by Sharecare —California
- $45 - $60 an hour
- Part-time
- Remote
- Nursing
- RN License
- Mid-level
Research Nurse 1
Stanford University —Stanford, CA
- $114,953 - $148,232 a year
- Full-time
- Hybrid work
- CPR Certification
- Nursing
- RN License
Private Duty Nurse (RN) – Concierge In-Home Care | Flexible Schedule | 1099 | Bay Area
TheKey Concierge Nursing —San Francisco, CA
- From $70 an hour
- 12 hour shift
- CPR Certification
- Patient monitoring
- RN License
- Flexible schedule
14d
Clin Research Nurse - BSN - OC
City of Hope —Irvine, CA
- $65.63 - $95.16 an hour
- Full-time
- Nursing
- RN License
- BLS Certification
Private Duty Nurse (RN) – Concierge In-Home Care | Flexible Schedule | 1099 | Santa Barbara
TheKey Concierge Nursing —Santa Barbara, CA
- From $70 an hour
- 8 hour shift
- CPR Certification
- Patient monitoring
- RN License
- Flexible schedule
14d
OBGYN Physician — Collaborative OBGYN/Midwifery Practice (Part-Time .5 FTE, No Call, Gyn Only))
Millie Inc —Los Gatos, CA
- $170,000 - $180,000 a year
- Part-time
- Surgery
- BC/BE
- Clinic experience
- Health insurance
- Dental insurance
Quick Apply
Part-Time OBGYN Physician — Collaborative OBGYN/Midwifery Practice
Millie Inc —Berkeley, CA
- $180,000 - $220,000 a year
- Part-time
- Background check
- Surgery
- BC/BE
- Health insurance
- Dental insurance
Quick Apply
Lead Certified Nurse Midwife - Bay Area Peninsula, CA
Millie Inc —Palo Alto, CA
- $160,000 - $200,000 a year
- Full-time
- Hospital
- BLS Certification
- Outpatient experience
- Health insurance
- Dental insurance
Quick Apply
3d
Mobile Pharmacist Per Diem
Advantage Healthcare Services —Fresno, CA
- $65 - $70 an hour
- Per diem
- Background check
- Mid-level
- Residential
- Employee assistance program
Quick Apply
Physician Assistant
HCP Talent —Sacramento, CA
- $131,000 - $170,000 a year
- Full-time
- Spanish
- BLS Certification
- English
- Paid holidays
- Relocation assistance
Quick Apply
Nurse Practitioner
HCP Talent —Sacramento, CA
- $131,000 - $170,000 a year
- Full-time
- Spanish
- RN License
- BLS Certification
- Paid holidays
- Relocation assistance
Quick Apply
Occupational Therapist (OT)
InHome Healthcare Services —Monterey, CA
- $60 - $90 an hour
- Full-time
- CPR Certification
- BLS Certification
- Mid-level
- Mileage reimbursement
- Fuel card
Quick Apply
Lead Physician
Cal Poly Pomona —Pomona, CA
- $49,476 - $158,291 a year
- 8 hour shift
- Acute care
- Background check
- CPR Certification
- Health savings account
- Relocation assistance
Quick Apply
Physical Therapist (PT)
InHome Healthcare Services —Monterey, CA
- $65 - $75 an hour
- Full-time
- CPR Certification
- BLS Certification
- Physical & Rehabilitation Medicine
- Fuel card
- Health insurance
Quick Apply
Occupational Therapist (OT)
Petaluma Post-Acute Rehab —Petaluma, CA
- $60 - $68 an hour
- Full-time
- CPR Certification
- Skilled nursing facility
- Management
- Disability insurance
- Relocation assistance
Quick Apply
Primary Care Physician Part Time
MEDIKO INC —Redding, CA
- $190 - $200 an hour
- 8 hour shift
- CPR Certification
- Medicine
- Psychiatry
- Wellness program
- 401(k)
Quick Apply
Occupational Therapist - Acute Care
PT Solutions Physical Therapy —Marysville, CA
- $55 - $65 an hour
- Acute care
- Hospital
- BLS Certification
- Paid time off
Per Diem Radiology RN (PRN) - Fountain Valley, CA
Aya Healthcare —Fountain Valley, CA
- $65 an hour
- 8 hour shift
- RN License
- BLS Certification
- Mid-level
- Health insurance
- Dental insurance
Quick Apply

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

Molina Healthcare -
California

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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

nurse clinician jobs in california

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

Clinical Appeals Nurse (Remote | Must have California LVN / RN License)

Risk Adjustment Registered Nurse

Research Nurse 1

Private Duty Nurse (RN) – Concierge In-Home Care | Flexible Schedule | 1099 | Bay Area

Clin Research Nurse - BSN - OC

Private Duty Nurse (RN) – Concierge In-Home Care | Flexible Schedule | 1099 | Santa Barbara

OBGYN Physician — Collaborative OBGYN/Midwifery Practice (Part-Time .5 FTE, No Call, Gyn Only))

Part-Time OBGYN Physician — Collaborative OBGYN/Midwifery Practice

Lead Certified Nurse Midwife - Bay Area Peninsula, CA

Mobile Pharmacist Per Diem

Physician Assistant

Nurse Practitioner

Occupational Therapist (OT)

Lead Physician

Physical Therapist (PT)

Occupational Therapist (OT)

Primary Care Physician Part Time

Occupational Therapist - Acute Care

Per Diem Radiology RN (PRN) - Fountain Valley, CA

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