2mo
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Utilization Specialist PRN
Riverside, California, United States
$31-$50/hr OnsiteAll Commitments Available
2+ YOEUR utilization management role in behavioral health; monitor utilization; coordinate with managed care; review medical necessity; respond to denials; requires high school diploma; clinical experience; licensure/certifications preferred.
Electronic Medical Records, Managed Care Systems, Reimbursement Systems
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.
1mo
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Director of Utilization
San Rafael, California, United States
$105k-$130k/yr OnsiteFull Time
4+ YOE3+ MgmtLead utilization review operations, conduct concurrent/retrospective reviews, ensure regulatory compliance, manage staff, liaise with payers, and optimize reimbursement; requires 4+ years utilization management and 3+ years supervisory experience.
1mo
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Utilization Clerk
Corona, California, United States
$23-$26/hr HybridFull Time
1+ YOEBilingual (English/Spanish) administrative clerk with 1+ year admin/scheduling or data-entry experience (healthcare preferred). Must handle EVV and EHR data, be HIPAA-compliant, proficient with Microsoft Office, and have a valid driver's license and reliable transportation.
Electronic Visit Verification (EVV), Family Room portal, WellSky platform, Microsoft Office, EHR platforms
1mo
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Supervisor, Utilization Management (RN)
California or Missouri
$75k-$135k/yr RemoteFull Time
4+ YOEGraduate of an accredited nursing program or bachelor's degree, active RN licensure (CA required or compact), 4+ years related experience, knowledge of utilization management, supervisory experience, strong communication and clinical judgment.
3w
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Utilization Review Tech III
San Mateo, California, United States
$48-$58/hr OnsiteFull Time
2+ YOERequires LVN or psychiatric technician credential, 2 years recent relevant experience, ability to work independently, critical thinking, organizational and communication skills; performs billing, denials, and appeals and reports on utilization topics.
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
3mo
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Supervisor of Utilization Management
Fairfield, California, United States
$136k-$177k/yr OnsiteFull Time
3+ YOE1+ MgmtRN with 3-5 years supervision and managed care experience; CA RN license; case management certification preferred; strong leadership and utilization management knowledge.
6d
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Utilization Management Authorization Assistant
Redlands, California, United States
$23-$29/hr OnsiteFull Time
2+ YOEHigh school diploma preferred; 2 years hospital experience in utilization review, case management or business office preferred; managed care experience and medical terminology knowledge desirable.
6d
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Utilization Management Nurse, LVN - Casual
California, United States
$36-$43/hr RemoteContract
2+ YOECalifornia LVN required, 2 years recent relevant experience, familiarity with utilization review, MCG/InterQual and coding (ICD-10,CPT,HCPCS) preferred, knowledge of payer systems and prior authorization processes.
MCG, InterQual, ICD-10, CPT, HCPCS, Tapestry
1mo
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Utilization Management Nurse, LVN/LPN
California, United States
$26-$40/hr OnsiteFull Time
2+ YOEActive California RN or LVN/LPN license required; 2+ years clinical nursing experience (1+ year in utilization review/case management preferred); CPUR/CCM/ACM preferred; proficiency with InterQual, MCG, EHR, and Microsoft Office.
InterQual, MCG, Electronic Health Records (EHR), utilization management software, Microsoft Office Suite
2mo
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RN Utilization Mgmt, Full-Time Day
Los Angeles, California, United States
$52-$81/hr OnsiteFull Time
3+ YOEAssociates Degree in Nursing; CA RN license; 3-5 years in Case/Utilization Management; UM/CM certification preferred; bilingual Spanish preferred; BLS; CCM preferred.
MEDICAL RECORDS, Cerner, e-TAR, InterQual, MCG
4d
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Utilization Review Tech
Santa Ana, California, United States
$25-$37/hr OnsiteFull Time
High school diploma, strong administrative and insurance knowledge, ability to manage payer correspondence, HIPAA compliance, typing 50 WPM, Microsoft Office proficiency; healthcare experience preferred.
Microsoft Word, Microsoft Outlook, Microsoft Excel, ICD-10, CPT
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
1w
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Utilization Review Clinician (RN) - OH License Required
Long Beach or United States
$24-$51/hr RemoteFull Time
2+ YOEActive Ohio RN license required, 2+ years clinical/utilization or managed care experience, proficiency with Microsoft Office/EMR, strong communication, prioritization and critical-thinking skills.
Microsoft Office
2mo
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Utilization Management Clinical Trainer (Hybrid Remote)
Orange or United States
$78k-$117k/yr HybridFull Time
5+ YOE5+ years nursing in managed care/utilization review; RN or LPN license; Bachelor’s in Nursing/Health or Education; experience in clinical training.
5d
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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.
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