Top 36 Clinical documentation & utilization review nurses Jobs in Folsom, Ca

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —Sacramento, CA
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
MDS Coordinator RN/LVN
Pine Creek Care Center —Roseville, CA
- From $120,000 a year
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
Quick Apply
Utilization Management Nurse, Senior
Blue Shield of California —El Dorado Hills, CA
- $90,860 - $136,290 a year
- Weekends as needed
- Hybrid work
- Background check
- Nursing
- RN License
- Work from home
Clinical Review Specialist (Roseville)
Adventist Health —Roseville, CA
- $81,273 - $121,909 a year
- Day shift
- Nursing
- RN License
- Mid-level
Clinical Documentation Integrity Specialist (Onsite, Roseville CA)
Adventist Health —Roseville, CA
- $46.75 - $64.13 an hour
- Day shift
- Nursing
- RN License
- Mid-level
Utilization Management Nurse (RN) (Temporary)
Central California Alliance for Health —Sacramento, CA
- $49.00 - $57.50 an hour
- Temporary
- Hybrid work
- Nursing
- RN License
- Mid-level
- Wellness program
- Paid holidays
Quick Apply
11d
Registered Nurse
Caring Hand Home Health Solutions, Inc. —El Dorado Hills, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Registered Nurse
Premier Home Health Providers Inc. —Granite Bay, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Appeals & Grievances Nurse
Western Health Advantage —Sacramento, CA
- $95,000 - $115,000 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
Quick Apply
MDS CONSULTANT RN
KALESTA HEALTHCARE GROUP —Sacramento, CA
- $160,000 - $185,000 a year
- Full-time
- Skilled nursing facility
- Up to 50% travel
- RN License
Quick Apply
MDS Coordinator
Pine Creek Care Center —Roseville, CA
- Full-time
- CPR Certification
- Nursing
- Experience working with individuals with disabilities
Quick Apply
MDS LPN LVN
Windsor El Camino Care Center —Carmichael, CA
- $83,200 - $89,400 a year
- Full-time
- Nursing
- Skilled nursing facility
- LVN
- Health insurance
- Dental insurance
Quick Apply
Appeals Professional III (Licensed Clinician)
Tanaq Support Services LLC —United States
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
12d

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MDS Coordinator - Registered Nurse | Licensed Practical Nurse
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clinical documentation & utilization review nurses jobs near folsom, ca

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

Molina Healthcare -
Sacramento, CA

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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.

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Refine Your Search

clinical documentation & utilization review nurses jobs in folsom, ca

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

MDS Coordinator RN/LVN

Utilization Management Nurse, Senior

Clinical Review Specialist (Roseville)

Clinical Documentation Integrity Specialist (Onsite, Roseville CA)

Utilization Management Nurse (RN) (Temporary)

Registered Nurse

Registered Nurse

Appeals & Grievances Nurse

MDS CONSULTANT RN

MDS Coordinator

MDS LPN LVN

Appeals Professional III (Licensed Clinician)

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