Top 9 Utilization review nurse Jobs in Sanger, Ca

UM Genetic Counselor Medical Reviewer
Wollborg Michelson Recruiting —California
- $62.00 - $64.70 an hour
- Full-time
- LVN
- Windows
- Master's degree
- Health insurance
- Dental insurance
Quick Apply
6d
Registered Nurse Clinicial Claims Review
Wollborg Michelson Recruiting —California
- $67.00 - $68.73 an hour
- Full-time
- Remote
- LVN
- RN License
- 5 years
- Health insurance
- Dental insurance
Quick Apply
6d
Peer Review Coordinator RN
Saint Agnes Medical Center —Fresno, CA
- $45.50 - $68.27 an hour
- Full-time
- Nursing
- RN License
- Hospital
Registered Nurse Case Manager
INNOVATIVE INTEGRATED HEALTH —Fresno, CA
- $55 - $58 an hour
- On call
- CPR Certification
- Nursing
- RN License
Admission Nurse (Home Health)
Dakmen Home Healthcare Agency —Fresno, CA
- $47.62 - $57.35 an hour
- Full-time
- Nursing
- RN License
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
6d
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance

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Registered Nurse Clinicial Claims Review
Wollborg Michelson Recruiting —California
Active RN or LVN license. Reviews clinical claims through post-service evaluation, assesses medical necessity and policy compliance, and determines whether…
$67.00 - $68.73 an hour
Quick Apply
6d

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utilization review nurse jobs near sanger, ca

UM Genetic Counselor Medical Reviewer

Wollborg Michelson Recruiting -
California

Quick Apply

Job Details

Full-time | Contract
$62.00 - $64.70 an hour
6 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Certified Genetic Counselor (CGC)
Windows
Master's degree
Clinical case management
Genetic counseling
Utilization management
Ad-hoc reporting

Full Job Description

Genetic Counselor
Job Summary

Provides clinical genetic counseling and supports utilization management activities involving genetic testing, medical necessity review, prior authorization, concurrent review, and post-service review.

Responsibilities

Evaluate genetic testing requests using clinical guidelines, medical policies, and medical necessity criteria.
Perform prior authorization, concurrent review, and post-service review activities.
Apply utilization management principles and applicable regulatory and accreditation standards.
Support the development and interpretation of genetic testing medical policies.
Document clinical decisions and communicate recommendations in a managed care or clinical environment.

Requirements

Master’s degree in Genetic Counseling from an accredited program.
Current certification as a Genetic Counselor or equivalent national certification.
Active, unrestricted genetic counselor licensure.
At least five years of relevant experience in genetic counseling, molecular medicine, genetic testing, carrier screening, prenatal testing, newborn testing, or neonatal intensive care.
At least three years of case management experience.
At least two years of experience as a registered nurse or licensed vocational nurse, with strong clinical judgment.
Experience with prior authorization, concurrent review, and post-service review preferred.
Experience in a health plan, administrative services, or independent practice association setting preferred.

Summary Qualification

Strong clinical understanding of molecular, cellular, and genetic medicine.
Knowledge of somatic and germline genetic testing and related clinical applications.
Working knowledge of utilization management, medical necessity review, regulatory requirements, and accreditation standards.
Strong analytical, clinical decision-making, and documentation skills.

Skill

Genetic counseling and clinical assessment.
Utilization management and case management.
Medical policy interpretation and development.
Prior authorization, concurrent review, and post-service review.
Strong computer skills with Windows-based applications.
Experience with Topaz and IBM FileNet preferred.

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one’s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one’s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.

Pay: $62.00 - $64.70 per hour

Benefits:

Dental insurance
Health insurance
Paid time off
Vision insurance

Work Location: Remote

Quick Apply

Refine Your Search

utilization review nurse jobs in sanger, ca

UM Genetic Counselor Medical Reviewer

Registered Nurse Clinicial Claims Review

Peer Review Coordinator RN

Registered Nurse Case Manager

Admission Nurse (Home Health)

Utilization Management Reviewer

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I want to receive the latest job alert for utilization review nurse in sanger, ca

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