Top 17 Utilization review nurse Jobs in Modesto, Ca

Care Manager II, Acute
Sutter Health —Modesto, CA
- $82.48 - $115.46 an hour
- Part-time
- Acute care
- Nursing
- RN License
Registered Nurse Case Manager (RN)
Doctors Hospital of Manteca —Manteca, CA
- Full-time
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
Medical Management Nurse
AllCare IPA —Modesto, CA
- From $50 an hour
- Full-time
- RN License
- Mid-level
- In-person
- Health insurance
- Dental insurance
Quick Apply
10d
PACE Care Coordinator Float RN (Merced, Modesto, and Stockton PACE Centers
Central Valley PACE —Modesto, CA
- $50.16 - $58.65 an hour
- Overtime
- Nursing
- Clean driving record
- LVN
- 403(b) matching
- Health insurance
Quick Apply
20h
Registered Nurse
Caring Hand Home Health Solutions, Inc. —Modesto, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Nurse Practitioner
Pacific Care Salida —Modesto, CA
- From $150,000 a year
- Full-time
- Anatomy knowledge
- Urgent Care
- HIPAA
Quick Apply
2d
Nurse Practitioner - Pulmonology
California Practice Staff —Modesto, CA
- Full-time
- Nursing
- RN License
- HIPAA
Bilingual Licensed Vocational Nurse (LVN) - Merced
LA FAMILIA —Turlock, CA
- $37.50 an hour
- Full-time
- Hybrid work
- Spanish
- Google Workspace
- Nursing
- Paid holidays
- Health insurance
Quick Apply
Nurse Practitioner/Physician Assistant - Urology - Modesto, CA
California Practice Staff —Modesto, CA
- Full-time
- CPR Certification
- Nursing
- BLS Certification

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RN Care Manager 40hrs weekly pay $3100
We Care Staffing Md LLC —California
Cardiopulmonary Resuscitation (CPR) certification or Basic Life Support (BLS OR HS-BLS OR RQIBLS) certification from approved vendor per AH policy: Required.
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RN Case Manager
Seva Hospice —Merced, CA
CA Registered Nurse license required. For this role, you need to be a registered nurse who sees the value of hospice care in alleviating pain and suffering.
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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
9d
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
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Care Manager II, Acute

Sutter Health -
Modesto, CA

Apply Now

Job Details

Part-time
$82.48 - $115.46 an hour

Qualifications

Collaborate with healthcare professionals
RN License
Cross-functional communication

Full Job Description

We are so glad you are interested in joining Sutter Health!

Organization:

SMCS-Valley Administration

Position Overview:

Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through effective resource coordination. The goals of this role are to include the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self –determination while coordinating in a timely and integrated fashion. He/She collaborates with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical and social situations efficiently in order to avoid unnecessary admissions.

Job Description:

EDUCATION:

Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:

RN-Registered Nurse of California Upon Hire

TYPICAL EXPERIENCE:

2 years of experience in acute care case management or health plan case management/utilization management

SKILLS AND KNOWLEDGE:

A broad knowledge base of health care delivery and case management within a managed care environment.

Comprehensive knowledge of Utilization Review, levels of care, and observation status.

Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems preferred.

Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC.

A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements.

General understanding of coding and DRG assignment process preferred.

Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.

Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.

Demonstrates commitment to service excellence in all patients, family and employee interactions and in performing all job responsibilities.

Functions in a manner to promote quality patient care and assure a positive patient experience.

Strong verbal and written communication skills and negotiation skills

Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.

Intermediate computer and technology skills.

Ability to promote teamwork and to effectively function in teams.

Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.

Job Shift:

Days

Schedule:

Short Hour

Shift Hours:

Days of the Week:

Variable

Weekend Requirements:

Rotating Weekends

Benefits:

Unions:

Position Status:

Non-Exempt

Weekly Hours:

Employee Status:

Short Hour

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $82.48 to $115.46 / hour

The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.

Apply Now

Refine Your Search

utilization review nurse jobs in modesto, ca

Care Manager II, Acute

Registered Nurse Case Manager (RN)

Medical Management Nurse

PACE Care Coordinator Float RN (Merced, Modesto, and Stockton PACE Centers

Registered Nurse

Nurse Practitioner

Nurse Practitioner - Pulmonology

Bilingual Licensed Vocational Nurse (LVN) - Merced

Nurse Practitioner/Physician Assistant - Urology - Modesto, CA

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