Top 48 Rn utilization review 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
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
Authorization Nurse, RN - 26-71
PriMed Management Consulting Services, Inc. —Sacramento, CA
- $100,000 - $123,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- LVN
Quick Apply
Authorization Nurse, RN - Hybrid (Remote Considered) - 26-88
PriMed Management Consulting Services, Inc. —Sacramento, CA
- $100,000 - $123,000 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- LVN
Quick Apply
10d
Authorization Nurse, RN - 26-66
PriMed Management Consulting Services, Inc. —Sacramento, CA
- $100,000 - $123,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- RN License
Quick Apply
4d
RN, Health Plan Care Manager
Adventist Health —Roseville, CA
- $45.39 - $62.26 an hour
- Nursing
- RN License
- Inpatient
Manager, Behavioral Health Utilization Management
Blue Shield of California —El Dorado Hills, CA
- $111,540 - $167,420 a year
- Full-time
- Hybrid work
- Background check
- LMFT
- Nursing
- Work from home
Manager, Utilization Management Nurse Management
Blue Shield of California —El Dorado Hills, CA
- $111,540 - $167,420 a year
- Full-time
- Hybrid work
- Background check
- Nursing
- RN License
- Work from home
RN Case Manager Full Time
Vibra Healthcare —Folsom, CA
- $60.00 - $84.60 an hour
- Full-time
- Nursing
- RN License
- BLS Certification
- Continuing education credits
- Health savings account
11d
CA Telephonic Case Manager I
CorVel Corporation —Folsom, CA
- $30.64 - $45.80 an hour
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
Case Manager - Ambulatory - 26-43
PriMed Management Consulting Services, Inc. —Sacramento, CA
- $100,000 - $123,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- RN License
Quick Apply
Manager, Case Management Nurse Management- Population Health Management
Blue Shield of California —Rancho Cordova, CA
- $111,540 - $167,420 a year
- Full-time
- Hybrid work
- Background check
- Nursing
- RN License
- Work from home
Care Manager, Registered Nurse
Sutter Health —Roseville, CA
- $82.48 - $115.46 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
Manager, Healthcare Services - Remote (Must Reside in California)
Molina Healthcare —Sacramento, CA
- $84,067 - $163,931 a year
- Full-time
- LMFT
- Nursing
- Microsoft Excel
- Health insurance
Appeals & Grievances Nurse
Western Health Advantage —Sacramento, CA
- $95,000 - $115,000 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
Quick Apply
Supervisor, Health Plan Clinical Operations, RN
Sutter Health —Sacramento, CA
- $198,556.80 - $277,971.20 a year
- Weekends as needed
- Master of Social Work
- Nursing
- RN License
9d
RN, Supervisor, Health Plan Care Management
Adventist Health —Roseville, CA
- $48.16 - $66.05 an hour
- Full-time
- Nursing
- RN License
- Inpatient
- Health insurance
14d
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Carmichael, CA
- $3,246 a week
- 8 hour shift
- Acute care
- Nursing
- RN License
Quick Apply
CA Medical Case Manager I
CorVel Corporation —Folsom, CA
- $30.64 - $45.80 an hour
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
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

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rn utilization review jobs near folsom, ca

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

Molina Healthcare -
Sacramento, CA

Apply Now

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

rn utilization review jobs in folsom, ca

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

Utilization Management Nurse, Senior

Authorization Nurse, RN - 26-71

Authorization Nurse, RN - Hybrid (Remote Considered) - 26-88

Authorization Nurse, RN - 26-66

RN, Health Plan Care Manager

Manager, Behavioral Health Utilization Management

Manager, Utilization Management Nurse Management

RN Case Manager Full Time

CA Telephonic Case Manager I

Case Manager - Ambulatory - 26-43

Manager, Case Management Nurse Management- Population Health Management

Care Manager, Registered Nurse

Manager, Healthcare Services - Remote (Must Reside in California)

Appeals & Grievances Nurse

Supervisor, Health Plan Clinical Operations, RN

RN, Supervisor, Health Plan Care Management

Travel RN - Case Management/Utilization Review - Case Management

CA Medical Case Manager I

MDS CONSULTANT RN

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