Providence: Provides comprehensive healthcare services through hospitals, clinics, and health plans.
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.
Vista del Mar Hospital: Provides inpatient and outpatient psychiatric and behavioral health services.
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.
BDR Solutions: Provider of IT, engineering, and consulting for federal agencies.
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
UCLA Health: Provides comprehensive hospital services and academic medical research.
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
KARL STORZ: Developer and manufacturer of endoscopic medical equipment.
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.
CSMC 8750000 Utilization Management Utilization Review Case Manager CS_PER_DIEM 48010 Allen PD68 0.01
Los Angeles, California, United States
$68-$75/hrRemotePart Time
Cedars-Sinai: Provides academic medical care, specialized treatment, and biomedical research.
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.
L.A. Care Health Plan: Public health plan providing coverage to Los Angeles residents.
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
myPlace Health: A PACE organization backed by a larger health plan that provides participant-centered care to help older adults live safely and independently in their communities.
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.
Director of Case Management - Utilization Management
Inglewood, California, United States
$108k-$164k/yrOnsiteFull Time
Prime Healthcare: Operates community hospitals and provides healthcare services.
5+ YOEDirector-level nursing leader with RN, BSN, 5+ years in case management and utilization review; LCSW preferred; strong analytical and computer skills.
MedPOINT Management: Provides administrative and management services for healthcare networks and hospitals.
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.
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/yrRemoteFull Time
UnitedHealth GroupNYSE: UNH: Provides health insurance and technology-enabled health care services.
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.
Director of Case Management - Utilization Management
Inglewood, California, United States
$108k-$164k/yrOnsiteFull Time
Prime Healthcare Services: Operates a nationwide network of acute care hospitals.
5+ YOERN with BSN; Licensed Clinical Social Worker; 5+ years case management; strong data analysis; basic computer skills; preferred BCLS; Milliman/InterQual knowledge.
Medical Review Institute of America: Provides independent clinical and utilization review services for healthcare.
5+ YOEMD or DO, Oregon medical license, board certification in Gastroenterology, minimum 5 years clinical experience, daytime availability for peer conversations, must adhere to HIPAA; remote US-based independent contractor.
Per Diem Registered Nurse II/III - Utilization Management VCMC
Ventura or Santa Paula
$55-$93/hrOnsitePart Time, Temporary
Ventura County: Provides essential public services and regional governance to residents.
0.5+ YOECalifornia RN license, BLS/CPR, graduation from an accredited school of nursing, pharmacology exam within 3 months; Per Diem RN II requires 6 months acute care experience; RN III requires 5 years acute care experience.
RN- Care Review Clinician- Utilization Review (Remote- CA License Req)
San Francisco or Los Angeles or San Jose or San Diego or Sacramento or Long Beach or California
$30-$59/hrRemoteFull Time
Molina HealthcareNYSE: MOH: Provides managed health insurance through government-sponsored benefit programs.
2+ YOEActive unrestricted RN license in state of practice (CA required for this posting), 2+ years clinical experience (acute care/prior authorization/managed care), UM/prior authorization experience preferred, Microsoft Office proficiency, strong communication and critical-thinking skills.
New York City or Milwaukee or Herndon or Dallas or Columbus or Kirkland or Irvine or Cincinnati or Cleveland or Oklahoma City or Austin or Albany or Chicago or Arlington or St. Petersburg or Hartford or Pittsburgh or St. Louis or Miami or Sacramento or Raleigh or Minneapolis or Mountain View or Scottsdale or Morristown or San Francisco or Denver or Boston or Philadelphia or Des Moines or Overland Park or Los Angeles or Charlotte or Walnut Creek or Carmel or Seattle or Houston or Arlington or Atlanta or Redmond or Bentonville or Beaverton or Nashville or Detroit or San Diego
$139k-$434k/yrHybridFull Time
AccentureNYSE: ACN: Global provider of management consulting and technology services.
10+ YOE10+ years in utility GIS solution architecture with full‑lifecycle ArcGIS Utility Network implementations; experience advising utility executives, defining enterprise GIS architecture, and leading large transformation programs; must be eligible to work in the US and willing to travel.