Top 27 Utilization review nurse Jobs in Rancho Cordova Ca

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
6d
Professional Review Nurse
CorVel Corporation —Folsom, CA
- $70,304 - $85,473 a year
- Full-time
- Remote
- Nursing
- RN License
- Data analysis skills
- Health savings account
- Disability insurance
Quick Apply
Care Review Clinician, RN/LPN
Molina Healthcare —Sacramento, CA
- $27.61 - $53.83 an hour
- Full-time
- Mid-level
- LPN
- Acute care experience
- Health insurance
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
Clinical Review Specialist (Roseville)
Adventist Health —Roseville, CA
- $81,273 - $121,909 a year
- Day shift
- Nursing
- RN License
- Mid-level
Sr. Clinical Denials Prevention Analyst (Remote)
Stanford Health Care —Sacramento, CA
- $66.52 - $88.14 an hour
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science in Nursing
4d
RN Case Manager
AMN Healthcare —Sacramento, CA
- $1,800 - $2,700 a week
- 8 hour shift
- RN License
- Hospital
- BLS Certification
- Paid jury duty
- Paid holidays
RN Case Manager
AMN Healthcare —Carmichael, CA
- $1,800 - $2,700 a week
- 8 hour shift
- Nursing
- RN License
- Hospital
- Paid jury duty
- Paid holidays
RN Case Manager
AMN Healthcare —Sacramento, CA
- $1,800 - $2,700 a week
- 8 hour shift
- RN License
- Hospital
- BLS Certification
- Paid jury duty
- Paid holidays
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
Care Coordinator RN
Methodist Hospital Sacramento —Sacramento, CA
- $74.56 - $90.51 an hour
- Part-time
- Acute care
- Nursing
- RN License
3d
LVN - SNF Quality & Clinical Operations
Community Health Centers of America —Fair Oaks, CA
- $40 - $45 an hour
- Full-time
- Nursing
- Skilled nursing facility
- Current TB test
Quick Apply
Patient Logistics Clinical Coordinator RN-CA
Dignity Health —Rancho Cordova, CA
- $52.15 - $77.58 an hour
- Full-time
- Acute care
- Nursing
- RN License
Care Manager, Registered Nurse
Sutter Health —Davis, CA
- $78.91 - $103.37 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
Registered Nurse
Caring Hand Home Health Solutions, Inc. —El Dorado Hills, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
RN, Health Plan Care Manager
Adventist Health —Roseville, CA
- $45.39 - $62.26 an hour
- Nursing
- RN License
- Inpatient
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
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Sacramento, CA
- $3,046 a week
- Contract
- RN License
- BLS Certification
- Mid-level
Quick Apply
5d
Per Diem IV Ketamine
Mindful Health Solutions —Sacramento, CA
- Part-time
- CPR Certification
- Nursing
- Microsoft Outlook
Quick Apply
Medicaid Medical Review RN (Medical Reviewer III)
CoventBridge Group —United States
- $65,000 - $70,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- Paid holidays
- Disability insurance
3d

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utilization review nurse jobs near rancho cordova ca

Utilization Management Nurse, Senior

Blue Shield of California -
El Dorado Hills, CA

Apply Now

Job Details

Full-time
$90,860 - $136,290 a year
6 days ago

Benefits

Work from home

Qualifications

Nursing
RN License
Associate's degree
Associate Degree in Nursing
Nursing

Full Job Description

Your Role

The Utilization Management team independently manages complex utilization and retrospective clinical reviews across multiple lines of business, assessing medical necessity, coding accuracy, treatment plans, discharge planning, and compliance requirements while supporting clinical consistency, process improvement, quality, timeliness, and appropriate escalation of high-risk cases.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work
In this role, you will:

Independently manages complex prospective, concurrent, and retrospective utilization reviews across multiple lines of business
Conducts retrospective clinical reviews of claims for medical necessity, coding accuracy, medical policy, and contract compliance
Serves as a clinical subject matter resource to peers by providing guidance on criteria application, documentation, and processes
Evaluates treatment plans, lengths of stay, and discharge planning to ensure quality, cost effective utilization of services
Identifies overpayment, third party liability, and coordination of benefits opportunities and initiates appropriate follow up
Supports process improvement efforts to enhance clinical consistency, efficiency, and regulatory compliance
Escalates complex or high risk cases to leadership or Medical Directors with clear clinical rationale
Works with minimal supervision while maintaining accountability for quality, accuracy, and timeliness
Ability to work evenings and weekends as part of rotating on-call schedule

Your Knowledge and Experience

Associate Degree in Nursing required
Bachelor of Science in Nursing or advanced degree is preferred
5 years of prior relevant experience managed care environment or clinical setting

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

ABOUT THE TEAM
About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

For most teams, this means coming into the office two days per week.
Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Apply Now

Refine Your Search

utilization review nurse jobs in rancho cordova ca

Utilization Management Nurse, Senior

Professional Review Nurse

Care Review Clinician, RN/LPN

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

Clinical Review Specialist (Roseville)

Sr. Clinical Denials Prevention Analyst (Remote)

RN Case Manager

RN Case Manager

RN Case Manager

CA Telephonic Case Manager I

Care Coordinator RN

LVN - SNF Quality & Clinical Operations

Patient Logistics Clinical Coordinator RN-CA

Care Manager, Registered Nurse

Registered Nurse

RN, Health Plan Care Manager

CA Medical Case Manager I

Travel RN - Case Management/Utilization Review - Case Management

Per Diem IV Ketamine

Medicaid Medical Review RN (Medical Reviewer III)

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