Top 29 Utilization review nurse Jobs in Santa Clara County 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
Utilization Specialist - Full Time
San Jose Behavioral Health —San Jose, CA
- $33 - $50 an hour
- Full-time
- Acute care
- LMFT
- CPR Certification
12d
Medical Field Case Manager
Enlyte —San Jose, CA
- $100,000 - $108,000 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Travel reimbursement
- Health savings account
Utilization Review Coordinator
The County of Santa Clara —Santa Clara County, CA
- $195,318.24 - $249,352.48 a year
- Acute care
- Psychiatry
- RN License
- Wellness program
- AD&D insurance
18h
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —San Jose, CA
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
Registered Nurse - Patient Flow Coordinator
US Veterans Health Administration —Palo Alto, CA
- $153,887 - $228,000 a year
- Online Application
- Background check
- Nursing
- Microsoft Excel
- Paid holidays
- Dental insurance
10h
Case Manager (RN) - Relief B status (0.4 FTE), 08-hr, Day Shift
Stanford Health Care —Palo Alto, CA
- $111.35 - $126.14 an hour
- Part-time
- Nursing
- RN License
- Hospital
Utilization Management and Discharge Planning RN
Santa Clara Family Health Plan —San Jose, CA
- $100,968 - $151,451 a year
- Full-time
- Nursing
- Clean driving record
- Microsoft Outlook
Quick Apply
Case Manager (RN) - Timely Discharge - 1.0 FTE, 08-hr, RotatingShift
Stanford Health Care —Palo Alto, CA
- $96.35 - $111.14 an hour
- Full-time
- Nursing
- RN License
- Hospital
2d
Utilization Management Nurse (RN) (Temporary)
Central California Alliance for Health —San Jose, CA
- $49.00 - $57.50 an hour
- Temporary
- Hybrid work
- Nursing
- RN License
- Mid-level
- Wellness program
- Paid holidays
Quick Apply
5d
Utilization Management - RN
Bickham Services Unlimited, LLC —Sunnyvale, CA
- Contract
- Nursing
- RN License
- Bachelor of Science
Quick Apply
Chief Nursing Executive
The County of Santa Clara —Santa Clara County, CA
- $311,259.51 - $399,410.71 a year
- Online Application
- Nursing
- RN License
- Master's degree
- Paid holidays
- Disability insurance
Temp RN Case Manager
Santa Clara Family Health Plan —San Jose, CA
- $113,836 - $176,446 a year
- Temporary
- Spanish
- Clean driving record
- Microsoft Outlook
Quick Apply
Registered Nurse
Best Home Health Providers, Inc. —San Jose, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Utilization Specialist - Full Time
The Camp Recovery Center —Scotts Valley, CA
- $25 - $27 an hour
- 8 hour shift
- CPR Certification
- Nursing
- RN License
- Health insurance
- Dental insurance
Case Manager RN
HumanGood —Los Altos, CA
- $118,000 - $144,000 a year
- Weekends as needed
- CPR Certification
- Nursing
- RN License
- Health savings account
- Health insurance
Quick Apply
Primary Care Provider, Nurse Practitioner / Physician Assistant
WelbeHealth —San Jose, CA
- $162,010.37 - $205,424.04 a year
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply
Remote Registered Nurse (RN) | $34/hr
Carenet Health —United States
- $34 an hour
- Weekends as needed
- Remote
- Bilingual
- Nursing
- RN License
- Continuing education credits
- Paid holidays

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Utilization Specialist - Full Time
San Jose Behavioral Health —San Jose, CA
LMFT, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required,…
$33 - $50 an hour
12d
Outpatient Medical Biller
Bay Area Surgical Management LLC —Santa Clara, CA
Knowledge and experience in state and government contracts, Non-profit human service, and Community-based Residential Program settings desired, but not required…
$28 - $30 an hour
Quick Apply

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Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
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Valid Ohio driver’s license and proof of auto insurance as required by hospital policy. Pediatric certification, Advanced-Continuity of Care Certification (A-…
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utilization review nurse jobs near santa clara county 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 santa clara county ca

UM Genetic Counselor Medical Reviewer

Utilization Specialist - Full Time

Medical Field Case Manager

Utilization Review Coordinator

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

Registered Nurse - Patient Flow Coordinator

Case Manager (RN) - Relief B status (0.4 FTE), 08-hr, Day Shift

Utilization Management and Discharge Planning RN

Case Manager (RN) - Timely Discharge - 1.0 FTE, 08-hr, RotatingShift

Utilization Management Nurse (RN) (Temporary)

Utilization Management - RN

Chief Nursing Executive

Temp RN Case Manager

Registered Nurse

Utilization Specialist - Full Time

Case Manager RN

Primary Care Provider, Nurse Practitioner / Physician Assistant

Remote Registered Nurse (RN) | $34/hr

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