Top 575 Rn transition in practice Jobs in California

Concurrent Utilization Review Nurse, RN
NeueHealth —Los Angeles, CA
- $74,286.15 - $111,429.23 a year
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
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Physician Assistant/Family Nurse Practitioner
Modoc Medical Center —Alturas, CA
- $144,830 - $214,510 a year
- Online Application
- Background check
- Nursing
- Skilled nursing facility
- AD&D insurance
- Relocation assistance
Quick Apply
Intake & Outreach Manager (Registered Nurse)
Asian Health Services —San Leandro, CA
- $135,000 - $145,600 a year
- Full-time
- RN License
- BLS Certification
- Mid-level
- Commuter assistance
- Paid holidays
Quick Apply
Admissions RN - Full Time
VITAS Healthcare —Lathrop, CA
- $57 - $63 an hour
- Full-time
- Nursing
- RN License
- Sales
- Disability insurance
- Health insurance
Quick Apply
12 hour NOC RN
Arbor Post-Acute Care —Chico, CA
- $45 - $55 an hour
- 12 hour shift
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply
LVN Nurse Case Manager
Centric Healthcare Services —Bakersfield, CA
- $30 - $35 an hour
- Full-time
- Nursing
- Skilled nursing facility
- LVN
- Health insurance
- Dental insurance
Quick Apply
Medicare Integrated Care Management Supervisor (RN or LCSW)
Health Plan of San Mateo —South San Francisco, CA
- $107,644 - $138,271 a year
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
RN Labor and Delivery Part-Time Nights
Martin Luther King, Jr. Community Hospital —Los Angeles, CA
- $52.25 - $83.56 an hour
- Part-time
- Background check
- Spanish
- Nursing
- Wellness program
- 403(b) matching
Quick Apply
Clinical Care Transition Specialist / Registered Nurse - Palo Alto
Option Care Health —Palo Alto, CA
- $93,332.10 - $155,561.01 a year
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
Clinical Care Transition Specialist / Registered Nurse - San Diego
Option Care Health —San Diego, CA
- $82,574.27 - $137,601.27 a year
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
Regional QA Consultant - Skilled Nursing
Renew Health Consulting Services —Monrovia, CA
- $160,000 - $200,000 a year
- Full-time
- Skilled nursing facility
- RN License
- 5 years
- Health insurance
- Dental insurance
Quick Apply
Nurse Practitioner (NP)
National Staffing Solutions —Crescent City, CA
- From $60 an hour
- Part-time
- Nursing
- RN License
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
2d
Case Manager - RN Full Time Day Shift
Community Hospital of Huntington Park —Huntington Park, CA
- $51.88 - $76.28 an hour
- Full-time
- Nursing
- RN License
- Hospital
Quick Apply
Case Manager - RN Full Time Day Shift
Coast Plaza Hospital —Norwalk, CA
- Full-time
- Nursing
- RN License
- Hospital
Quick Apply
Nurse Practitioner (NP)
National Staffing Solutions —Redding, CA
- $550 - $600 a day
- Part-time
- Nursing
- RN License
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
6d
Case Manager II, RN
Clever Care Health Plan —Huntington Beach, CA
- $88,355 - $100,000 a year
- Full-time
- Hybrid work
- Background check
- Spanish
- Nursing
Case Manager II, RN
Clever Care Health Plan —Arcadia, CA
- $88,355 - $100,000 a year
- Full-time
- Hybrid work
- Background check
- Spanish
- Nursing
RN Wound Treatment Nurse
Madera Care Center —Madera, CA
- $42 - $50 an hour
- Full-time
- Background check
- Skilled nursing facility
- RN License
- Disability insurance
- Health insurance
Quick Apply
13d
RN Manager, Case Management
Torrance Memorial IPA —Torrance, CA
- $108,805 - $175,760 a year
- Weekends as needed
- RN License
- Hospital
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
Primary Care Nurse (RN required)
West County Health Centers, Inc. —Sebastopol, CA
- From $42 an hour
- Full-time
- CPR Certification
- RN License
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
7d

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Concurrent Utilization Review Nurse, RN

NeueHealth -
Los Angeles, CA

Quick Apply

Job Details

$74,286.15 - $111,429.23 a year

Benefits

Paid holidays
Health insurance
Paid time off
401(k) matching

Qualifications

RN License

Full Job Description

WHO WE ARE

NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

NeueHealth delivers clinical care to health consumers through our owned clinics – Centrum Health and Premier Medical – as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.

Job Summary:

The Concurrent Utilization Review (UR) Nurse is responsible for conducting real-time clinical reviews to ensure the medical necessity and appropriateness of healthcare services provided to members under a managed care health plan. This role involves assessing inpatient admission and continued stays, coordinating with healthcare providers, facilitating communication with payers, and ensuring compliance with health plan policies and clinical guidelines. The UR Nurse collaborates with the Medical Director and clinical leadership for complex cases, denials, and escalated reviews.

Key Responsibilities:

1. Concurrent Review & Case Assessment

Conduct timely reviews of inpatient and skilled nursing services to determine medical necessity and appropriateness based on established clinical guidelines (e.g., InterQual, MCG).
Evaluate clinical documentation to support level-of-care determinations, treatment plans, and continued hospital stays.
Ensure adherence to health plan policies, clinical criteria, and regulatory requirements.

2. Collaboration with Medical Director

Review and escalate complex or borderline cases to the Medical Director for further assessment.
Provide the Medical Director with comprehensive clinical summaries, including case history, treatment plans, and justifications for continued care or level-of-care decisions.
Collaborate with the Medical Director to develop treatment recommendations and resolve discrepancies in care.

3. Authorization & Payer Communication

Process authorization requests for inpatient hospital admissions, LTAC, inpatient rehab, and skilled nursing admissions.
Communicate with healthcare providers to request additional documentation or clarify treatment plans.
Ensure timely approvals or denials of requested services per the health plan's benefit structure and clinical guidelines.
Escalate cases to the Medical Director or higher clinical authority when necessary.

4. Care Coordination & Discharge Planning Support

Work closely with case managers, social workers, and care teams to facilitate seamless care transitions.
Participate in interdisciplinary discussions to address complex cases and ensure members receive appropriate care.
Identify and escalate discharge barriers to support timely and effective discharge planning.
Assist in transitioning patients from inpatient to outpatient or post-acute care settings.

5. Compliance & Documentation

Ensure compliance with state and federal regulations, accreditation standards (e.g., NCQA, URAC), and health plan policies.
Maintain accurate, up-to-date documentation of all concurrent review activities, including authorizations, denials, escalations, and Medical Director reviews.
Support quality improvement initiatives by tracking utilization trends and identifying resource optimization opportunities.

6. Education & Collaboration

Educate providers and staff on health plan clinical guidelines, medical necessity criteria, and authorization processes.
Provide guidance on escalating complex cases to the Medical Director.
Stay updated on industry trends, regulatory changes, and best practices in utilization management.
Participate in interdisciplinary team meetings and case conferences.

Qualifications:

Education: Registered Nurse (RN) with an active, unrestricted California nursing license required; BSN preferred.
Experience:
- Minimum of 2-3 years of clinical nursing experience, with at least 1 year in utilization review, case management, or a related field.
- Experience in a managed care setting with medical necessity reviews is strongly preferred.
Certifications:
- Preferred: Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), or Accredited Case Manager (ACM).
- Additional clinical nursing or case management certifications are a plus.
Skills:
- Strong knowledge of clinical guidelines (e.g., InterQual, MCG) and medical necessity criteria.
- Excellent communication and interpersonal skills to collaborate with healthcare providers, payers, and members.
- Strong analytical skills and attention to detail in reviewing clinical documentation.
- Proficiency in electronic health records (EHR), utilization management software, and Microsoft Office Suite.

Performance Metrics:

1. Timeliness of Reviews & Authorizations

Percentage of concurrent reviews completed within the required turnaround time (TAT).
Average response time for provider inquiries and authorization requests.

2. Compliance & Accuracy

Adherence to regulatory and accreditation requirements (e.g., CMS, NCQA, URAC).
Accuracy in applying medical necessity guidelines and compliance with internal policies.
Results of internal audits and quality assurance reviews.

3. Case Escalation Efficiency

Percentage of complex cases escalated to the Medical Director in a timely manner.
Turnaround time for resolving escalated cases.

4. Utilization & Cost Management

Reduction in unnecessary inpatient days through appropriate level-of-care determinations.
Cost savings achieved through effective utilization management and alternative care recommendations.
Reduction in readmission rates related to premature discharges.

Work Environment:

Office-based setting.
Collaborative environment requiring frequent communication with clinical and administrative teams.

EEO/AFFIRMATIVE ACTION STATEMENT

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

For individuals assigned to a location(s) in California, NeueHealth is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant's education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $74,286.15-$111,429.23 Annually.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; Paid Time Off, and paid holidays.

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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Refine Your Search

rn transition in practice jobs in california

Concurrent Utilization Review Nurse, RN

Physician Assistant/Family Nurse Practitioner

Intake & Outreach Manager (Registered Nurse)

Admissions RN - Full Time

12 hour NOC RN

LVN Nurse Case Manager

Medicare Integrated Care Management Supervisor (RN or LCSW)

RN Labor and Delivery Part-Time Nights

Clinical Care Transition Specialist / Registered Nurse - Palo Alto

Clinical Care Transition Specialist / Registered Nurse - San Diego

Regional QA Consultant - Skilled Nursing

Nurse Practitioner (NP)

Case Manager - RN Full Time Day Shift

Case Manager - RN Full Time Day Shift

Nurse Practitioner (NP)

Case Manager II, RN

Case Manager II, RN

RN Wound Treatment Nurse

RN Manager, Case Management

Primary Care Nurse (RN required)

I want to receive the latest job alert for rn transition in practice in california

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