Top 35 Clinical documentation & utilization review nurses Jobs in Fremont, Ca

Utilization Review Coordinator
The County of Santa Clara —Santa Clara County, CA
- $195,318.24 - $249,352.48 a year
- Acute care
- Psychiatry
- RN License
- Wellness program
- AD&D insurance
8h
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —San Jose, CA
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
Utilization Management Nurse (RN) (Temporary)
Central California Alliance for Health —San Jose, CA
- $49.00 - $57.50 an hour
- Temporary
- Hybrid work
- Nursing
- RN License
- Mid-level
- Wellness program
- Paid holidays
Quick Apply
5d
Utilization Management and Discharge Planning RN
Santa Clara Family Health Plan —San Jose, CA
- $100,968 - $151,451 a year
- Full-time
- Nursing
- Clean driving record
- Microsoft Outlook
Quick Apply
Authorization Nurse, RN - Hybrid (Remote Considered) - 26-88
PriMed Management Consulting Services, Inc. —San Ramon, CA
- $100,000 - $123,000 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- LVN
Quick Apply
Utilization Specialist - Full Time
San Jose Behavioral Health —San Jose, CA
- $33 - $50 an hour
- Full-time
- Acute care
- LMFT
- CPR Certification
11d
Registered Nurse
Best Home Health Providers, Inc. —Half Moon Bay, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Regional MDS Consultant (Clinical Reimbursement Consultant)
Confidential —Fremont, CA
- $120,000 - $130,000 a year
- Full-time
- 5 years
- Travel
- US work authorization
- Health insurance
- Dental insurance
Quick Apply
Utilization Management - RN
Bickham Services Unlimited, LLC —Sunnyvale, CA
- Contract
- Nursing
- RN License
- Bachelor of Science
Quick Apply
Registered Nurse
Premier Home Health Providers Inc. —San Jose, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
9d
Utilization Management Nurse, RN
Altais Health Solutions —Oakland, CA
- $44.63 - $53.55 an hour
- Full-time
- Background check
- RN License
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
2d
Utilization Management Nurse, LVN - Casual
Altais Health Solutions —Oakland, CA
- $36 - $43 an hour
- Full-time
- Background check
- LVN
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
Registered Nurse
Affinity Hospice Care Inc. —Santa Clara, CA
- $140 - $150 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
MDS CONSULTANT RN
KALESTA HEALTHCARE GROUP —Menlo Park, CA
- $160,000 - $185,000 a year
- Full-time
- Skilled nursing facility
- Up to 50% travel
- RN License
Quick Apply
RN MDS Coordinator (Weekends)
Plum Tree Care Center —San Jose, CA
- $55.00 - $62.50 an hour
- Part-time
- Background check
- RN License
- Pass drug screening
Quick Apply
6d
AHD Minimum Data Set (MDS) Coordinator SS
Alameda Health System —Alameda, CA
- Per diem
- Nursing
- Skilled nursing facility
- RN License
Quick Apply
Hospice Registered Nurse
Best Hospice Providers Inc. —San Jose, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
MDS Coordinator (RN/LVN)
Avondale Villa Post-Acute —Livermore, CA
- $45 - $60 an hour
- Full-time
- Nursing
- Skilled nursing facility
- LVN
- Paid training
- AD&D insurance
Quick Apply
MDS Coordinator (RN/LVN)
Stratford Villa Post-Acute —Livermore, CA
- $45 - $60 an hour
- Full-time
- Nursing
- Skilled nursing facility
- LVN
- Paid training
- AD&D insurance
Quick Apply
Registered Nurse
Madrona Hospice Care Inc. —San Jose, CA
- $140 - $150 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply

I want to receive the latest job alert for clinical documentation & utilization review nurses in fremont, ca

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

clinical documentation & utilization review nurses jobs near fremont, ca

Utilization Review Coordinator

The County of Santa Clara -
Santa Clara County, CA

Apply Now

Job Details

$195,318.24 - $249,352.48 a year
8 hours ago

Benefits

Wellness program
457(b)
AD&D insurance
Paid holidays
Disability insurance
Dependent care reimbursement
Health insurance
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Pension plan
Employee assistance program
Vision insurance
Life insurance

Qualifications

Collaborate with healthcare professionals
Statistics
Report preparation
Record keeping
Inpatient experience
Medicare
RN License
Acute care facility experience
Medicare regulations
Medicaid regulations
Medical terminology
Nursing

Full Job Description

Description

Under direction, to review, monitor and assess utilization of hospital services; to administer Utilization Review procedures as required under federal, state, and county regulations as well as Valley Medical Center's Utilization Review plan or Public Health CCS guidelines.

Only applicants who provide proof of current certification as a Registered Nurse by the State of California, Department of Health Services certificate attached to their application will be accepted. All other applicants will be rejected. This recruitment is to establish an Extra-Help eligible list for the APS Psychiatric Utilization Review.

Because we serve patients throughout multiple hospitals and clinics, you may have to work at different sites. We will meet any obligations we may have when this occurs.

The Power of WE: Together, we can make a greater impact. Bringing better care and expanding healthcare services across the community.

Santa Clara Valley Healthcare (SCVH) is the second largest public health care system in California and includes three acute care hospitals, 14 clinics and 60+ specialty and sub-specialty services. Our mission is to provide high-quality, accessible healthcare and excellent service to everyone in Santa Clara County.

Because we serve patients throughout multiple hospitals and clinics, you may have to work at different sites. We will meet any obligations we may have when this occurs.

Santa Clara Valley Medical Center - SCVMC is a full-service tertiary acute care teaching hospital with 699 licensed beds providing a wide range of specialized services, including Rehabilitation, Burn, Trauma, and NICU. SCVMC was ranked by U.S. News and World Report as #6 Rehabilitation Hospital in the nation and #1 in the West and designated as a 2024 High Performing hospital for Maternity Care, Heart Failure, Stroke, Hip Fracture, and Pneumonia.

O'Connor Hospital- O'Connor Hospital (OCH) is a 358 licensed bed acute care facility offering a full range of inpatient and outpatient medical, surgical and specialty programs to residents of Santa Clara County. It was founded in 1889 as one of the first hospitals in the county. OCH has grown significantly over the past five years in both its inpatient volume and its Emergency Department visits. Along with these volume increases other ancillary and clinical departments like imaging, lab, pharmacy, and respiratory have seen growth as well.

St. Louise Regional Hospital- Since 1989, St. Louise Regional Hospital (SLRH) has been caring for the residents in Santa Clara and San Benito Counties, offering a wide range of inpatient and outpatient medical specialties. SLRH has 93 beds, is a Designated Primary Stroke Center, and is the only acute care hospital in the area. Located in Gilroy, SLRH maintains a CALSTAR 2 emergency helicopter base on the premises.

Regional Medical Center– Regional Medical Center (RMC) is a 258-bed hospital that is the main emergency healthcare provider for East San José, treating a wide range of critical and life-threatening conditions for more than 60 years. Since the SCVH integration of RMC effective 4/1/25, RMC has expanded the critical services including Level II trauma, Thrombectomy capable Stroke Center and STEMI care, and has been seeing an increased number of emergency visits and inpatient volume.

Learn more about Santa Clara Valley Healthcare: https://www.scvh.org/homeand follow us on: LinkedIn | www.linkedin.com/company/county-of-santa-clara/

Facebook | www.facebook.com/sccjob

Instagram |www.instagram.com/sccjobs/

Newsletter Subscription | Sign Up

Typical Tasks

Monitors admissions of patients for hospital care;
Reviews justification for services;
Reviews and certifies patient stays, need for acute hospitalization and/or indicated outpatient services, and need for length of stay extensions;
Prepares documentation related to appropriate payment for services;
Maintains close liaison with all levels of professional hospital staff;
Maintains liaison with other county departments and outside health care agencies;
Investigates and documents rejected insurance claims;
Participates in and provides assistance with patient audit activities;
Facilitates compliance with Utilization Review regulations;
Conducts concurrent review of all inpatients;
Traces medical billings to be paid;
Acts as resource in referral of outpatient discharges;
Prepares and maintains appropriate records and/or documents and submits reports as required;
Maintains a working knowledge of current regulations affecting patient care services and related fiscal programs;
May assist in preparation of billing claims;
May perform the above duties and provide medical case management primarily in relation to patients under the California Childrens Services program;
Performs other related duties as assigned.

Employment Standards

Possession of a current California RN license.

Experience Note: The knowledge and abilities required would normally be acquired by two (2) years of recent nursing experience in an acute care hospital setting. Utilization Review experience in an acute care setting is desirable.

Knowledge of:

Hospital organization, operations and procedures;
Federal and state health care laws and regulations common to the operation of hospitals in California;
Regulations of intermediary agencies pertaining to hospital stay coverage (e.g. Medicare and Medi-Cal);
Medical terminology and related levels of care and treatment;
Data processing systems as relating to Utilization Review;
Evaluation and assessment techniques;
Record keeping and reporting procedures.

Ability to:

Maintain effective reporting systems;
Collect and record data;
Interact with all levels of hospital staff;
Maintain close liaison with hospital resources;
Interpret health care laws, regulations and procedures;
Evaluate data and statistics;
Work independently;
Communicate effectively orally and in writing.

Apply Now

Refine Your Search

clinical documentation & utilization review nurses jobs in fremont, ca

Utilization Review Coordinator

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

Utilization Management Nurse (RN) (Temporary)

Utilization Management and Discharge Planning RN

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

Utilization Specialist - Full Time

Registered Nurse

Regional MDS Consultant (Clinical Reimbursement Consultant)

Utilization Management - RN

Registered Nurse

Utilization Management Nurse, RN

Utilization Management Nurse, LVN - Casual

Registered Nurse

MDS CONSULTANT RN

RN MDS Coordinator (Weekends)

AHD Minimum Data Set (MDS) Coordinator SS

Hospice Registered Nurse

MDS Coordinator (RN/LVN)

MDS Coordinator (RN/LVN)

Registered Nurse

I want to receive the latest job alert for clinical documentation & utilization review nurses in fremont, ca

Explore jobs in more locations

Description

Typical Tasks

Employment Standards

Job Seeker Tools

Employer Tools

Browse

Stay Connected