Top 8285 Practice nurse Jobs in California

Utilization Management and Discharge Planning RN
Santa Clara Family Health Plan —San Jose, CA
- $100,968 - $151,451 a year
- Temporary
- Hybrid work
- Nursing
- Skilled nursing facility
- RN License
- Wellness program
- Health insurance
Quick Apply
11d
Chief Nursing Officer
Community Hospital of Huntington Park —Huntington Park, CA
- $211,577.60 - $311,064.00 a year
- Nursing
- RN License
- Hospital
Quick Apply
Registered Nurse RN
RecSol Recovery Solutions —Ventura, CA
- $47.76 - $58.38 an hour
- Full-time
- Nursing
- RN License
- Mid-level
- Wellness program
- Health savings account
Quick Apply
10d
Clinical Nurse III - Wound Care
The County of Santa Clara —San Jose, CA
- $183,605.76 - $246,084.80 a year
- 8 hour shift
- Nursing
- Psychiatry
- RN License
- Wellness program
- AD&D insurance
9d
Registered Nurse – Aesthetic Training Provided
LaserAway —Walnut Creek, CA
- $50 an hour
- 8 hour shift
- Surgery
- Mid-level
- Critical & Intensive Care
- Disability insurance
- Health insurance
Quick Apply
Psychiatric Nurse
County of San Diego —San Diego, CA
- $130,020.80 a year
- Full-time
- Acute care
- Background check
- CPR Certification
9d
Case Manager, Registered Nurse (Oncology experience required)
CVS Health —California
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
October 2026 RN Residency Program - New Graduate and Acute Care Transition Nurses
Cottage Health —Santa Barbara, CA
- $55.75 an hour
- Acute care
- Nursing
- Surgery
Quick Apply
10d
Registered Nurse – Aesthetic Training Provided
LaserAway —Dublin, CA
- $50 an hour
- 8 hour shift
- Surgery
- Mid-level
- Critical & Intensive Care
- Disability insurance
- Health insurance
Quick Apply
Patient Placement Coordinator RN - Full time Variable
Providence Health and Services —Anaheim, CA
- $57.28 - $88.92 an hour
- Part-time
- Nursing
- RN License
- High school
- Paid parental leave
- Paid holidays
Care Manager RN Full- time Day
Providence Health and Services —Torrance, CA
- $57.28 - $88.92 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
8d
Care Manager RN Full- time Day
Providence Health and Services —Glendale, CA
- $57.28 - $88.92 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
8d
Care Manager RN Full- time Day
Providence Health and Services —Santa Monica, CA
- $57.28 - $88.92 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
10d
Patient Placement Coordinator RN - Full time Variable
Providence —Anaheim, CA
- $57.28 - $88.92 an hour
- Full-time
- Nursing
- RN License
- High school
- Paid parental leave
- Paid holidays
Clinical Admission Nurse-RN NOC. Per diem.
Loma Linda University Health —Loma Linda, CA
- $68.71 - $92.41 an hour
- Night shift
- Nursing
- Microsoft Outlook
- Patient monitoring
New Graduate Registered Nurse (RN)
Redlands Community Hospital - SURGICAL SERVICES —Redlands, CA
- $46.16 an hour
- Full-time
- Nursing
- BLS Certification
- Entry level
20h
Clinic Nurse, RN
WelbeHealth —Carson, CA
- $47.74 - $63.02 an hour
- CPR Certification
- Nursing
- Vital signs
- Health insurance
- Dental insurance
Quick Apply
6d
Pediatric RN, Outpatient
Shriners Hospitals for Children —Sacramento, CA
- $42.44 - $82.23 an hour
- Full-time
- 18 years or older
- Nursing
- RN License
Quick Apply
9d
CSU Clinical RN
Palomar Health —Escondido, CA
- $54.15 - $78.82 an hour
- Part-time
- Nursing
- Psychiatry
- RN License
Quick Apply
10d
Registered Nurse (RN) – New Graduates Welcome!
BFF Medical Wellness Clinic —Temecula, CA
- $38 - $45 an hour
- CPR Certification
- Nursing
- RN License
Quick Apply

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practice nurse jobs near california

Utilization Management and Discharge Planning RN

Santa Clara Family Health Plan -
San Jose, CA

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Job Details

Temporary
$100,968 - $151,451 a year
11 days ago

Benefits

Wellness program
Health insurance
On-site gym
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Life insurance
Referral program
Retirement plan

Qualifications

Medicare
Utilization review
Managed care
RN License
Pre-authorization review for utilization management
Case management
Utilization management
Centers for Medicare and Medicaid Services (CMS)
Healthcare compliance

Full Job Description

About Us:

Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Working in partnership with providers and community organizations, we serve our neighbors through our Medi-Cal and SCFHP DualConnect (HMO D-SNP) health care plans.

About the role:

The Utilization Management and Discharge Planning Nurse performs clinical review in accordance with applicable regulatory and professional standards for Organization Determination Requests using clinical experience and skills in a collaborative process to assess, plan, implement, coordinate and evaluate options to ensure appropriate utilization of member healthcare services and benefits for all lines-of-business in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.

Day to Day:

Conduct clinical review to ensure effective and appropriate utilization of benefits and services for prospective, concurrent and retrospective/claims review organization determination authorization requests within regulatory turnaround requirements for all SCFHP lines of business.
Complete authorization reviews by applying the appropriate clinical criteria/guidelines, policy, procedures and clinical judgment to render coverage determinations.
Document pre-admission status, including living arrangements, physical and mental function, social support, durable medical equipment (DME), and other services received.
Draft appropriate notification letters such as approval, denial, delay and modify notifications to providers and members and language threshold following regulatory requirements..
Perform onsite concurrent review activities, as needed in the home, facility or community setting. For Long Term Care UR RN: Conduct regularly scheduled on-site visits to contracted skilled nursing facilities to follow up on re-admissions, confirm member census, conduct member assessments and provide on-site utilization and concurrent review.
Review and monitor hospital or nursing facility census and internal reports to track, reconcile and update discrepancies in member case files. For Long Term UR RN: Monitor and oversee re-admission and transfer prevention strategy.
Facilitate and coordinate communication related to post discharge with member interdisciplinary care team (ICT) including physicians, specialists, public services, community agencies and vendors to ensure care plan development and coordination of benefits and services.
Apply the use of clinical judgment to identify and coordinate referrals to appropriate departments or programs for member identified continuity of care needs, such as Case Management, Behavioral Health, Managed Long Term Services and Supports (MLTSS), community resources, Pharmacy and Quality.
Proactively and collaboratively interface with external case management staff including delegates to facilitate discharge planning and care transitions.
Maintain adherence with Model of Care of CMC, LTSS and DHCS regulatory requirements.

About You:

Active California Board of Nursing License (RN) without restriction.
Minimum one year of licensed related health care experience.
Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management.
Knowledge of MediCal and/or Medicare guidelines and regulations.
One year of experience with a Managed Care Health Plan.
Knowledge of Milliman/MCG guidelines or other nationally accredited utilization review criteria or standards.
Ability to make determinations based on Nursing knowledge when no criteria are available or applicable.
Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance.
Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care needs necessary to develop an effective care plan.
Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children).

Please review the full job description on our Career’s page: https://phf.tbe.taleo.net/phf04/ats/careers/v2/viewRequisition?org=SANTCLAR2&cws=38&rid=3170

Job Type: Temporary

Pay: $100,968.00 - $151,451.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Employee assistance program
Flexible spending account
Health insurance
Life insurance
On-site gym
Paid time off
Referral program
Retirement plan
Tuition reimbursement
Vision insurance
Wellness program

Application Question(s):

Do you have Knowledge of Milliman/MCG guidelines or other nationally accredited utilization review criteria or standards?
Do you have experience in reviewing clinical criteria to make determinations?

Experience:

licensed related health care: 1 year (Required)
Managed Care Health Plan: 1 year (Preferred)
MediCal and/or Medicare : 1 year (Required)

License/Certification:

RN License (Required)

Work Location: Hybrid remote in San Jose, CA 95119

Quick Apply

Refine Your Search

practice nurse jobs in california

Utilization Management and Discharge Planning RN

Chief Nursing Officer

Registered Nurse RN

Clinical Nurse III - Wound Care

Registered Nurse – Aesthetic Training Provided

Psychiatric Nurse

Case Manager, Registered Nurse (Oncology experience required)

October 2026 RN Residency Program - New Graduate and Acute Care Transition Nurses

Registered Nurse – Aesthetic Training Provided

Patient Placement Coordinator RN - Full time Variable

Care Manager RN Full- time Day

Care Manager RN Full- time Day

Care Manager RN Full- time Day

Patient Placement Coordinator RN - Full time Variable

Clinical Admission Nurse-RN NOC. Per diem.

New Graduate Registered Nurse (RN)

Clinic Nurse, RN

Pediatric RN, Outpatient

CSU Clinical RN

Registered Nurse (RN) – New Graduates Welcome!

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