Top 21 Utilization review nurse Jobs in Sacramento, Ca

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
Patient Logistics Clinical Coordinator RN-CA
Dignity Health —Rancho Cordova, CA
- $52.15 - $77.58 an hour
- Full-time
- Acute care
- Nursing
- RN License
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
Clinical Review Specialist (Roseville)
Adventist Health —Roseville, CA
- $81,273 - $121,909 a year
- Day shift
- Nursing
- RN License
- Mid-level
Care Coordinator RN
Methodist Hospital Sacramento —Sacramento, CA
- $98.49 an hour
- PRN
- Acute care
- Nursing
- RN License
Care Manager, Registered Nurse
Sutter Health —Roseville, CA
- $82.48 - $115.46 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
RN, Health Plan Care Manager
Adventist Health —Roseville, CA
- $45.39 - $62.26 an hour
- Nursing
- RN License
- Inpatient
Medical Case Management Nurse
Sacramento County, CA —Sacramento, CA
- $53.32 - $64.82 an hour
- Weekends as needed
- Background check
- CPR Certification
- Nursing
14d
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
Medical Coordinator
PMA Companies —Roseville, CA
- Microsoft Outlook
- Mid-level
- Mentoring
9d
RN Case Manager Full Time
Vibra Healthcare —Folsom, CA
- $60.00 - $84.60 an hour
- Full-time
- Nursing
- RN License
- BLS Certification
- Continuing education credits
- Health savings account
10d
Case Manager - Ambulatory - 26-43
PriMed Management Consulting Services, Inc. —Sacramento, CA
- $100,000 - $123,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- RN License
Quick Apply
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
Registered Nurse
Caring Hand Home Health Solutions, Inc. —Davis, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Carmichael, CA
- $3,246 a week
- 8 hour shift
- Acute care
- Nursing
- RN License
Quick Apply
Universal RN | Full Time
InnovAge —Sacramento, CA
- $44.66 - $58.08 an hour
- Email
- Background check
- Spanish
- Nursing
- AD&D insurance
- Paid holidays
3d
Psychiatric Nurse Practitioner or Physician Assistant
Bay Area Community Services —Sacramento, CA
- $80 - $120 an hour
- 8 hour shift
- Management
- Psychiatry
- Adults
- Health insurance
- Dental insurance
Quick Apply
Primary Care Provider, Nurse Practitioner / Physician Assistant
WelbeHealth —Elk Grove, CA
- $150,009.60 - $190,207.44 a year
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply
8d

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RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —Sacramento, CA
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
$30.37 - $59.21 an hour
Quality Assurance Nurse
CorVel Corporation —Folsom, CA
Develop and oversee case management manager mentor program to facilitate the onboarding of new supervision and management to equip field with the tools for…
$61,053 - $98,334 a year
Quick Apply
10d

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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…
$40.40 an hour
9d

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utilization review nurse jobs near sacramento, ca

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

Molina Healthcare -
Sacramento, CA

Apply Now

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

utilization review nurse jobs in sacramento, ca

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

Patient Logistics Clinical Coordinator RN-CA

Utilization Management Nurse, Senior

Clinical Review Specialist (Roseville)

Care Coordinator RN

Care Manager, Registered Nurse

RN, Health Plan Care Manager

Medical Case Management Nurse

CA Telephonic Case Manager I

Medical Coordinator

RN Case Manager Full Time

Case Manager - Ambulatory - 26-43

CA Medical Case Manager I

Registered Nurse

Travel RN - Case Management/Utilization Review - Case Management

Universal RN | Full Time

Psychiatric Nurse Practitioner or Physician Assistant

Primary Care Provider, Nurse Practitioner / Physician Assistant

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