1d
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Utilization Management Assistant - Utilization Management
Mission Hills, California, United States
$25-$34/hr OnsiteFull Time
1+ YOE1 year experience in hospital, insurance, or medical office; familiarity with utilization/case management, medical terminology and coding; CMA upon hire preferred; college coursework or associate degree preferred.
3w
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Utilization Analyst PT36 Nights
Downey, California, United States
$31-$33/hr OnsitePart Time
Coordinate and supervise utilization data collection, analysis and reporting; strong analytic, verbal and computer skills; knowledge of health plan benefits and hospital operations; high school diploma required.
Health Connect, Mainframe
1mo
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LVN Utilization Review Coordinator
Ventura, California, United States
OnsiteFull Time
Associate or equivalent training; LVN and LPT required; one year utilization/chart review experience preferred; computer, data entry and filing skills; performs data collection, non-medical analysis, recordkeeping and clerical support.
1w
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Coordinator II, Utilization Management
Montebello, California, United States
$27-$34/hr HybridFull Time
2+ YOEHigh school diploma required; 2+ years medical billing or utilization management experience with pre-authorizations and government program knowledge (Medi-Cal, CCS); MA or medical billing certificate preferred; prior lead experience preferred.
2w
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Utilization Management Lead
Lancaster, California, United States
$27-$37/hr OnsiteFull Time
High school diploma or equivalency; effective verbal/written communication; proficiency with Microsoft Word, Excel, PowerPoint, EZ-Cap, Medic, Report Riter, and NextGen EHR; ability to supervise staff and analyze reports; knowledge of Medicare/Medicaid and managed care regulations.
Microsoft Word, Microsoft Excel, Microsoft PowerPoint, EZ-Cap, Medic, Report Riter, NextGen EHR
1mo
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Acquisition Utilization Specialist
Los Angeles, California, United States
$72k-$75k/yr OnsiteFull Time
3+ YOE3–5+ years federal acquisitions or healthcare procurement experience; bachelor’s in related field or equivalent; U.S. citizenship and ability to obtain Public Trust; experience with eCMS and procurement docs; strong Microsoft Office skills.
Electronic Contract Management System (eCMS), Microsoft Excel, Microsoft PowerPoint, Microsoft Word
3w
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Utilization Review Coordinator
Long Beach, California, United States
$26-$28/hr OnsiteFull Time
2+ YOEAuditing charts, managing Medi-Cal/TAR submissions and appeals, verifying insurance eligibility, maintaining patient and payer records, 2+ years behavioral health/hospital experience, EHR proficiency, strong communication and computer skills.
Electronic Health Records (EHR), LA County TAR Unit Database, Medi-Cal system
6d
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Medical Director Utilization Management Oncology
Cerritos or California or Nevada or Arizona or Oregon or Florida
$275k-$325k/yr RemoteFull Time
5+ YOEMedical degree (MD or DO) and oncology board certification; minimum 5 years clinical oncology experience and 2+ years utilization management experience; strong analytical and communication skills; ability to review treatment appropriateness.
1w
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Manager, Behavioral Health Utilization Management
El Dorado Hills or California or Long Beach or Lodi or Oakland or Rancho Cordova or Redding or San Diego or Woodland Hills
$112k-$167k/yr HybridFull Time
7+ YOE3+ MgmtCurrent unrestricted CA LMFT, LCSW, LPCC, PhD/PsyD or RN license; doctoral/master/associate degree requirements by license; 7+ years relevant experience; 3 years management; utilization management experience preferred.
2mo
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Utilization Review (UR) Assistant
Long Beach, California, United States
$21-$26/hr OnsiteFull Time
1+ YOEHigh School graduate or GED preferred; 1 year acute care/hospital experience preferred; medical terminology knowledge required.
1mo
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Utilization Management Supervisor, Non-Clinical
Los Angeles, California, United States
$71k-$145k/yr HybridFull Time
4+ YOE3+ MgmtHigh school diploma/GED or equivalent; 4+ years in managed care case management/care coordination, 3+ years in inpatient and ambulatory managed care referrals, 3+ years supervisory experience; experience with Epic/CareConnect and Microsoft Office.
Epic, CareConnect, Microsoft Excel, Microsoft Visio, Microsoft PowerPoint, Microsoft Word
1w
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Customer Success Utilization Manager
Los Angeles, California, United States
$91k-$118k/yr FieldFull Time
1+ YOE2+ years OR/technical or KARL STORZ-specific experience preferred, Bachelor's degree or equivalent experience, strong technical acumen with OR1 and video integration, willingness to travel up to 80%, hospital credentialing may be required.
OR1, Salesforce
1mo
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CSMC 8750000 Utilization Management Utilization Review Case Manager CS_PER_DIEM 48010 Allen PD68 0.01
Los Angeles, California, United States
$68-$75/hr RemotePart Time
3+ YOEGraduate of accredited nursing program and current CA RN license required; BLS required; 3+ years acute care nursing experience; 2+ years case management preferred; knowledge of reimbursement and medical literature; flu vaccine required.
InterQual, MCG
3w
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Utilization Management Nurse Specialist RN II
Los Angeles, California, United States
$89k-$142k/yr OnsiteFull Time
5+ YOEActive California RN license, 5+ years varied acute hospital RN experience, 2+ years UM/CM experience, managed care knowledge preferred, strong computer and communication skills, NCQA/DHCS/CMS knowledge preferred, HIPAA compliance.
Outlook, Word, Excel, PowerPoint, L.A. Care Information System
2w
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Registered Nurse - Utilization Management
Los Angeles or Los Angeles
$53-$58/yr OnsiteFull Time
3+ YOEActive unrestricted RN license, minimum 3 years nursing experience, knowledge of Medicare/Medicaid and utilization review, strong clinical judgment, EMR proficiency, and relevant certifications (CCM/CPUR/CPHM) preferred.
Electronic Medical Records (EMR)
2mo
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Director of Case Management - Utilization Management
Inglewood, California, United States
$108k-$164k/yr OnsiteFull Time
5+ YOEDirector-level nursing leader with RN, BSN, 5+ years in case management and utilization review; LCSW preferred; strong analytical and computer skills.
Milliman Criteria, InterQual Criteria
1mo
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Outpatient UM Clinician
Sherman Oaks or United States
$36-$48/hr RemoteFull Time
2+ YOELicensed clinician (nursing, social work, or related), 2+ years utilization or case management experience, proficient with electronic health records, strong communication and regulatory knowledge.
Electronic Health Records (EHR)
1mo
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UM Review Nurse
Monterey Park or California
$34-$47/hr RemoteFull Time
1+ YOEActive CA LVN license, 1+ year outpatient utilization management experience, proficiency with Microsoft Word/Excel/Outlook, open availability 8AM-8PM (M-Su), ability to follow medical necessity criteria and internal policies.
Microsoft Word, Microsoft Excel, Microsoft Outlook
2mo
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Utilization Management Medical Director - Medical Oncology - Remote anywhere in US
Houston or Chicago or Atlanta or Phoenix or Los Angeles or Saint Louis or San Diego or Dallas or Philadelphia or Seattle
$249k-$373k/yr RemoteFull Time
5+ YOEMD or DO with current medical license; Board Certification in Oncology; 5+ years clinical experience in oncology; NCCN guideline experience; able to support utilization review and case/disease management.
6d
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Case Manager (RN) - Utilization Management
San Dimas, California, United States
$42-$56/hr OnsiteTemporary
5+ YOECurrent state RN license, minimum 5 years post-graduate experience, BCLS (AHA) preferred, knowledge of Milliman and InterQual criteria preferred, basic-to-intermediate computer skills, case management/discharge planning experience preferred.
Milliman Criteria, InterQual Criteria