Top 69 Utilization review nurse Jobs in Orange, Ca

Inpatient Review Nurse (Remote | California RN/LVN License Required | Pacific Time Schedule)
Alignment Healthcare USA, LLC —Orange, CA
- $77,905 - $116,858 a year
- Full-time
- Remote
- Nursing
- RN License
- Basic math
Quick Apply
8d
Clinical Documentation Specialist 4 HX - Clinical Doc Integrity - FT Days HYBRID
University of California, Irvine —Irvine, CA
- $125,363.52 - $242,333.28 a year
- Weekends as needed
- Background check
- Nursing
- Customer service
- Health insurance
- Retirement plan
7d
Nurse Navigator - DHI Admin SL - FT Days
University of California, Irvine —Orange, CA
- $68.86 - $100.34 an hour
- Full-time
- Background check
- Spanish
- Nursing
- Health insurance
- Retirement plan
7d
Clinical Documentation Specialist 4 HX - Clinical Doc Integrity - P/T Days Remote
University of California, Irvine —Irvine, CA
- $119,400 - $230,800 a year
- Part-time
- Remote
- Background check
- Nursing
- Medicine
- Health insurance
- Retirement plan
RN Case Manager - ED - Days - FT - Orange
University of California, Irvine —Orange, CA
- $68.86 - $100.34 an hour
- Full-time
- Background check
- Nursing
- RN License
- Health insurance
- Retirement plan
2d
Utilization Review Nurse LVN
Prime Healthcare Management Inc —Ontario, CA
- $71,760 - $99,590 a year
- Full-time
- LVN
- HIPAA
- Mid-level
- Health insurance
- Dental insurance
RN Case Manager - case management - Days - PT - Irvine
University of California, Irvine —Irvine, CA
- $68.86 - $100.34 an hour
- Part-time
- Background check
- Nursing
- RN License
- Health insurance
- Retirement plan
2d
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Orange, CA
- $2,645.91 a week
- Contract
- Nursing
- Blood sampling
- Surgery
Quick Apply
1d
Clinical Review Nurse - Prior Authorization
Akido —Chino, CA
- $62,400 - $93,600 a year
- Nursing
- RN License
- Mid-level
Quick Apply
Case Manager - Utilization Management
West Anaheim Medical Center —Anaheim, CA
- $30.28 - $43.32 an hour
- Full-time
- Acute care
- Hospital
- Computer literacy
- Health insurance
- Dental insurance
6d
RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Covina, California
Emanate Health —Covina, CA
- $52.03 - $80.64 an hour
- 8 hour shift
- RN License
- Customer service
- Computer literacy
- Health insurance
- Dental insurance
Clinical Documentation Integrity (CDI) Review
CareConnectMD Inc —Costa Mesa, CA
- Full-time
- Microsoft Outlook
- HIPAA
- Quality control
Quick Apply
Utilization Review RN
Prime Healthcare Management Inc —Ontario, CA
- $71,760 - $104,000 a year
- Full-time
- Nursing
- RN License
- Computer literacy
- Health insurance
- Dental insurance
LVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Covina, California
Emanate Health —Covina, CA
- $31.03 - $46.54 an hour
- 8 hour shift
- LVN
- Customer service
- Computer literacy
RN Case Manager - Per Diem -Days - 8hr FPH Glendora, California
Emanate Health —Glendora, CA
- $84 an hour
- 8 hour shift
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
RN Case Manager - Per Diem - Days - 8hr FPH Glendora, California
Emanate Health —Glendora, CA
- $84 an hour
- 8 hour shift
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
RN Case Manager, Full time, 8:30am-5:00pm
PIH Health —Whittier, CA
- $55.00 - $87.50 an hour
- Full-time
- Nursing
- RN License
- Hospital
Care Manager
CareConnect Health Services Inc —Costa Mesa, CA
- Full-time
- Microsoft Excel
- Skilled nursing facility
- LVN
- COVID-19 protective measures
Quick Apply
RN Case Manager (PD-Days)
KPC GLOBAL MEDICAL CENTERS INC. —Santa Ana, CA
- $42.89 - $64.33 an hour
- Full-time
- Acute care
- RN License
- Computer literacy
- AD&D insurance
- Health insurance
Quick Apply
Home Health Visiting Registered Nurse/Licensed Vocational Nurse/Licensed Practical Nurse
Ambassadore Health Care, Inc. —Long Beach, CA
- $35 - $120 an hour
- Part-time
- Background check
- CPR Certification
- LVN
Quick Apply
9d

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utilization review nurse jobs near orange, ca

Inpatient Review Nurse (Remote | California RN/LVN License Required | Pacific Time Schedule)

Alignment Healthcare USA, LLC -
Orange, CA

Quick Apply

Job Details

Full-time
$77,905 - $116,858 a year
8 days ago

Qualifications

Collaborate with healthcare professionals
Statistics
Inpatient experience
Medicare
Utilization review
RN License
Managed care organization experience
Team leadership
Basic math
Managing patients as a nurse case manager
Utilization management
Resource utilization in healthcare
Data interpretation
Relationship management
Milliman Care Guidelines (MCG Health)

Full Job Description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. As an inpatient review nurse, you will assist patients through the continuum of care in collaboration with the patient’s primary care physician, facility case manager, discharge planner and employing contracted ancillary service providers and community resources as needed. Assure that services are provided at the most appropriate, cost effective level of care needed to meet the patient’s medical needs while maintaining safety and quality.

Schedule (Required)
- Monday - Friday
- 8:00 AM - 5:00 PM Pacific Time

GENERAL DUTIES / RESPONSIBILITIES:
1. Performs reviews of inpatients with complex medical and social problems.
2. Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient’s primary care physician.
3. Performs follow-up reviews and evaluations of patients in the ambulatory care or lower level of care setting.
4. Reviews inpatient admissions timely and identifies appropriate level of care and continued stay based on acceptable evidence-based guidelines used by AHC.
5. Effectively communicates with patients, their families and or support systems, and collaborates with physicians and ancillary service providers to coordinate care activities.
6. Identifies Members who may need complex or chronic case management post discharge and warm handoff to appropriate staff for ambulatory follow up, as necessary.
7. Communicates and collaborates with IPA/MG as necessary for effective management of Members.
8. Assigns and provides daily oversight of the activities and tasks of the CCIP Coordinator.
9. Records communications in EZ-Cap and/or case management database.
10. Arranges and participates in multi-disciplinary patient care conferences or rounds.
11. Monitors, documents, and reports pertinent clinical criteria as established per UM policy and procedure.
12. Monitors for any over utilization or underutilization activities.
13. Generates referrals as appropriate to the QM department.
14. Enters data as necessary for the generation of reports related to case management.
15. Reports the progress of all open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management.
16. Performs other duties as assigned.

Minimum Requirements:

Experience:

Required:

Minimum (3) years' general case management skills.
Minimum (2) years' experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation Length of stay: including review of diagnosis and length of stay.
Minimum (2) consecutive years related experience in a managed care setting as an inpatient case manager

Preferred:
Experience with a senior population.

Education:

Required: Successful completion of an accredited Licensed Vocational Nursing Program
Preferred: Associates or Bachelors Degree

Specialized Skills:

Required:

Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Excellent critical thinking skills related to nursing utilization review
Knowledge of Medicare Managed Care Plans
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
Report Analysis Skills: Comprehend and analyze statistical reports.

Preferred:
Knowledge and experience in complex / catastrophic case management preferred

Licensure:

Required:

Must have and maintain an active, valid, and unrestricted RN license in California (Non-Compact)
Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1 While performing the duties of this job, the employee is regularly required to sit; use hands to finger, hand, or feel and talk or hear.

2 The employee is frequently required to reach with hands and arms

3 The employee is occasionally required to climb or balance and stoop, or kneel

4 The employee must occasionally lift and/or move up to 20 pounds.

5 Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Pay Range: $77,905.00 - $116,858.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].

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Refine Your Search

utilization review nurse jobs in orange, ca

Inpatient Review Nurse (Remote | California RN/LVN License Required | Pacific Time Schedule)

Clinical Documentation Specialist 4 HX - Clinical Doc Integrity - FT Days HYBRID

Nurse Navigator - DHI Admin SL - FT Days

Clinical Documentation Specialist 4 HX - Clinical Doc Integrity - P/T Days Remote

RN Case Manager - ED - Days - FT - Orange

Utilization Review Nurse LVN

RN Case Manager - case management - Days - PT - Irvine

Travel RN - Case Management/Utilization Review - Case Management

Clinical Review Nurse - Prior Authorization

Case Manager - Utilization Management

RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Covina, California

Clinical Documentation Integrity (CDI) Review

Utilization Review RN

LVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Covina, California

RN Case Manager - Per Diem -Days - 8hr FPH Glendora, California

RN Case Manager - Per Diem - Days - 8hr FPH Glendora, California

RN Case Manager, Full time, 8:30am-5:00pm

Care Manager

RN Case Manager (PD-Days)

Home Health Visiting Registered Nurse/Licensed Vocational Nurse/Licensed Practical Nurse

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