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
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
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.
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.
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
5d
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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.
2d
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Utilization Review RN Part- time Day - REMOTE
Irvine, California, United States
$57-$89/hr RemotePart Time
2+ YOEAssociate degree in Nursing, California RN license upon hire, 2 years UR remote or acute hospital case management experience; Interqual experience preferred; strong utilization management and clinical review skills.
Interqual
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.
4w
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Utilization Review Supervisor RN
Rancho Cucamonga, California, United States
$78k-$120k/yr RemoteFull Time
3+ YOEActive RN licensure, graduate of accredited nursing program (diploma/associate required; BS/BSN preferred), 3+ years clinical experience (rehabilitation preferred), management/supervisory experience, national certification (CCM preferred), and Microsoft Office/Excel proficiency.
Microsoft Office, Microsoft Excel
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
1d
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ED Case Management Utilization RN, 32/hr Night
Baldwin Park, California, United States
$65-$79/hr OnsitePart Time
2+ YOEActive California RN license, BLS, 2+ years acute care or case management RN experience, knowledge of utilization review/discharge planning, regulatory standards, strong communication and computer skills.
1mo
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Utilization Review Case Manager
San Juan Capistrano, California, United States
$30-$35/hr OnsiteFull Time
0.5+ YOEMust be 18+, high school diploma or equivalent, pass background check, at least 6 months behavioral health/substance abuse experience, able to type 40 WPM, proficient with Microsoft Office/Adobe/G Suite, knowledge of insurance criteria.
Microsoft Office, Adobe Acrobat, G Suite
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
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 UM/CM experience; BLS; CCM preferred; bilingual Spanish preferred.
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