Top 19 Clinical documentation & utilization review nurses Jobs in La Jolla, Ca

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —San Diego, CA
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
Acute Care Case Manager II
Palomar Health —Escondido, CA
- $54.15 - $78.82 an hour
- 8 hour shift
- Acute care
- RN License
- Hospital
Quick Apply
RN Lead Utilization Management Specialist - Appeals
Sanford Health —San Diego, CA
- $29.00 - $46.50 an hour
- 8 hour shift
- Remote
- Background check
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
Senior Clinical Reimbursement Specialist
Veracyte —San Diego, CA
- $86,098 - $107,850 a year
- Email
- Remote
- Nursing
- Analysis skills
- Mentoring
Quick Apply
13d
PACE Utilization Management Registered Nurse
San Ysidro Health —San Diego, CA
- $50.29 - $66.27 an hour
- Full-time
- Nursing
- RN License
- Customer service
Quick Apply
RN MDS Coordinator - Stanford Court SNF
Stanford Court Skilled Nursing & Rehab Center —Santee, CA
- $115,000 - $135,000 a year
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
- Health insurance
- Opportunities for advancement
Quick Apply
5d
Clinical Specialist
Apreva Hospice —San Diego, CA
- $105,000 - $110,000 a year
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Mileage reimbursement
- Health insurance
MDS Coordinator
Stillwater Post-Acute —El Cajon, CA
- $45 - $50 an hour
- Full-time
- Nursing
- Skilled nursing facility
- LVN
- Health insurance
- Dental insurance
Quick Apply
MDS coordinator LVN - SNF - Sharp Grossmont - Days - Full Time
Sharp HealthCare —La Mesa, CA
- $32.73 - $45.81 an hour
- 8 hour shift
- Nursing
- Skilled nursing facility
- LVN
- Disability insurance
- Health insurance
6d
MDS Coordinator LVN - Sub Acute Care - Sharp Coronado Hospital - Days - Full Time
Sharp HealthCare —Coronado, CA
- $32.73 - $45.81 an hour
- 8 hour shift
- Acute care
- Nursing
- LVN
- Disability insurance
- Health insurance
MDS Nurse LVN
La Paloma Healthcare Center —Oceanside, CA
- Full-time
- Nursing
- Skilled nursing facility
- LVN
Quick Apply
2d
MDS Nurse LVN- Part Time
La Paloma Healthcare Center —Oceanside, CA
- $40 - $42 an hour
- Part-time
- Skilled nursing facility
- LVN
- Basic math
Quick Apply
2d
MDS Coordinator
Poway Healthcare Center —Poway, CA
- $100,000 - $135,000 a year
- Full-time
- Nursing
- Skilled nursing facility
- Bachelor of Science
Quick Apply
MDS Coordinator - RN
Pacific Villas Post Acute —Oceanside, CA
- $100,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
Quick Apply
Appeals Professional III (Licensed Clinician)
Tanaq Support Services LLC —United States
- Full-time
- Remote
- Nursing
- RN License
- Writing skills

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clinical documentation & utilization review nurses jobs near la jolla, ca

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

Molina Healthcare -
San Diego, 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 la jolla, ca

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

Acute Care Case Manager II

RN Lead Utilization Management Specialist - Appeals

Senior Clinical Reimbursement Specialist

PACE Utilization Management Registered Nurse

RN MDS Coordinator - Stanford Court SNF

Clinical Specialist

MDS Coordinator

MDS coordinator LVN - SNF - Sharp Grossmont - Days - Full Time

MDS Coordinator LVN - Sub Acute Care - Sharp Coronado Hospital - Days - Full Time

MDS Nurse LVN

MDS Nurse LVN- Part Time

MDS Coordinator

MDS Coordinator - RN

Appeals Professional III (Licensed Clinician)

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