Top 28 Utilization review nurse Jobs in Vallejo Ca

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —San Francisco, CA
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
Case Manager, Registered Nurse
Sutter Health —San Francisco, CA
- $84.50 - $114.34 an hour
- 8 hour shift
- Nursing
- RN License
- Customer service
12d
Care Manager II, Registered Nurse Acute
Sutter Health —Oakland, CA
- $90.58 - $126.81 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
Care Manager II, Acute ( RN )
Sutter Health —Novato, CA
- $90.58 - $126.81 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
6d
Care Manager RN Per Diem Day
Providence —Napa, CA
- $72.23 - $99.98 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
12d
Utilization Management Nurse, LVN - Casual
Altais Health Solutions —Oakland, CA
- $36 - $43 an hour
- Full-time
- Background check
- LVN
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
10d
IV Ketamine RN
Mindful Health Solutions —Oakland, CA
- $65 - $70 an hour
- Full-time
- CPR Certification
- Nursing
- Microsoft Outlook
Quick Apply
Per Diem IV Ketamine RN
Mindful Health Solutions —Oakland, CA
- $65 - $70 an hour
- Part-time
- CPR Certification
- Nursing
- Microsoft Outlook
Quick Apply
Registered Nurse
Caring Hand Home Health Solutions, Inc. —Vallejo, CA
- $110 - $130 a year
- Part-time
- Remote
- CPR Certification
- RN License
- BLS Certification
- Mileage reimbursement
- Flexible schedule
Quick Apply
Case Manager RN
Novato Healthcare Center —Novato, CA
- $45 - $55 an hour
- Full-time
- Mid-level
- Administrative experience
- Bachelor's degree
Quick Apply
Registered Nurse
Best Home Health Providers, Inc. —Napa, 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 —Oakland, CA
- $3,171 a week
- Rotating weekends
- Acute care
- RN License
- Hospital
Quick Apply

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RN - IV Wellness Clinic - Per Diem
Hydration Room —San Francisco, CA
Prolonged periods sitting at a desk and working on a computer. BSN or diploma in nursing. Guaranteed earnings up to $67/hour during your first six months…
$57 - $67 an hour
Quick Apply
Case Manager RN
The Terraces at Los Altos - a HumanGood community —Los Altos, CA
Current, active Registered Nurse license in the state of employment, in good standing and without restriction. Bachelor of Science in Nursing.
$118,000 - $144,000 a year
Quick Apply
12d

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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
11d
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…
11d

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utilization review nurse jobs near vallejo ca

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

Molina Healthcare -
San Francisco, CA

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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 vallejo ca

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

Case Manager, Registered Nurse

Care Manager II, Registered Nurse Acute

Care Manager II, Acute ( RN )

Care Manager RN Per Diem Day

Utilization Management Nurse, LVN - Casual

IV Ketamine RN

Per Diem IV Ketamine RN

Registered Nurse

Case Manager RN

Registered Nurse

Travel RN - Case Management/Utilization Review - Case Management

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