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84 utilization nurse jobs at 27 companies in Los Angeles, CA

4w
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Utilization Review Nurse LVN
Ontario, California, United States
$72k-$100k/yr OnsiteFull Time
Prime Healthcare
Prime Healthcare: Operates acute care hospitals and outpatient facilities in the US.
2+ YOEActive California LVN, 2+ years acute hospital case management, utilization management experience, High School/GED, knowledge of coding and billing, strong interpersonal skills.
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4w
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Utilization Review Nurse LVN
Ontario, California, United States
$72k-$100k/yr OnsiteFull Time
Prime Healthcare Services
Prime Healthcare Services: Operates a nationwide network of acute care hospitals.
2+ YOEActive CA LVN license, 2+ years acute hospital case management, utilization management experience, knowledge of claims, coding and billing, high school diploma/GED, strong interpersonal skills.
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1mo
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Utilization Management Nurse, Senior
El Dorado Hills or California or Long Beach or Lodi or Oakland or Rancho Cordova or Redding or San Diego or Woodland Hills
$91k-$154k/yr HybridFull Time
Ascendiun
Ascendiun: Nonprofit parent overseeing health insurance and clinical service organizations.
5+ YOEAssociate Degree in Nursing required, active unrestricted RN license (or ability to obtain additional state licenses within 90 days), 5+ years relevant experience in managed care or clinical setting, BLS preferred, ability to work rotating on-call/evening/weekend schedule.
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8h
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Utilization Management Nurse Specialist RN II (Outpatient)
Los Angeles, California, United States
$89k-$142k/yr OnsiteFull Time
L.A. Care Health Plan
L.A. Care Health Plan: Public health plan providing coverage to Los Angeles residents.
5+ YOERequires an associate nursing degree, active unrestricted California RN license, 5 years acute hospital RN experience, and 2 years utilization or case management experience. Computer and communication skills required.
Microsoft Outlook, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, HIPAA, National Committee for Quality Assurance (NCQA), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS)
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3mo
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CA Utilization Review Nurse I
Rancho Cucamonga, California, United States
$31-$46/hr RemoteFull Time
CorVel
CorVelNASDAQ: CRVL: Provides technology-driven risk management and healthcare cost containment services.
4+ YOERegistered nurse with 4+ years clinical experience; current RN license; knowledge of CPT/ICD coding; remote role; strong communication and data analysis skills.
Microsoft Office, CPT coding, ICD coding
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2mo
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Registered Nurse - Utilization and Care Transitions
Riverside, California, United States
$50-$75/hr OnsiteFull Time
Neighborhood Healthcare
Neighborhood Healthcare: Provides integrated medical, dental, and behavioral health services.
3+ YOEBachelor's in nursing, active CA RN license, current AHA BLS (hands-on) required, 3+ years clinical nursing with 1+ year in transitional care/case management or utilization review, valid CA driver's license and auto insurance, ability to travel locally.
EMR
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16h
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Registered Nurse - Utilization Management - 8 Hour Per Deim
Los Angeles, California, United States
$68-$75/hr RemotePart Time
Cedars-Sinai
Cedars-Sinai: Provides academic medical care, specialized treatment, and biomedical research.
3+ YOEAssociate degree in nursing and 3 years of acute nursing experience required. RN state license and BLS required; case management and CPT coding experience, plus a bachelor's degree, preferred.
InterQual, MCG, CMS Two-Midnight Rule, R1, Medicare, Medicaid, CPT
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15h
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Case Manager Utilization RN, Per Diem Day
Woodland Hills, California, United States
$78-$95/hr OnsitePart Time
Kaiser Permanente
Kaiser Permanente: Provides integrated medical care and health insurance plans.
2+ YOECalifornia RN license and BLS required, with 2 years of combined acute care or case management experience. Requires utilization management, discharge planning, communication, critical thinking, and computer skills.
Computer
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2mo
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Utilization Management Assistant Director - RN
Los Angeles, California, United States
$116k-$265k/yr HybridFull Time
UCLA Health
UCLA Health: Provides comprehensive hospital services and academic medical research.
5+ YOE3+ MgmtLead ICM and UM programs; supervise RN and social work staff; ensure CMS/NCQA compliance; 5-7 years clinical with 3-5 years leadership; CA RN license; BSN.
Microsoft Excel, Visio, PowerPoint, Word
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2d
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Case Manager (RN) - Utilization Management
San Dimas, California, United States
$50/hr OnsitePart Time
Prime Healthcare
Prime Healthcare: Operates community hospitals and provides healthcare services.
5+ YOERequires 5 years of post-graduation nursing experience, an active RN license, and 1 year in case management, discharge planning, or nursing management. CCM, acute care, BCLS, and utilization criteria knowledge preferred.
Milliman Criteria, InterQual
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6d
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Registered Nurse, Case Manager & Care Coordinator Team Lead FLOAT
Commerce, California, United States
$104k/yr OnsiteFull Time
AltaMed
AltaMed: Provides comprehensive healthcare services to underserved Southern California communities.
California RN license and BLS certification required. One year of experience is preferred in geriatric nursing and managed care, utilization, or case management.
Flexible Spending Accounts
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2mo
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Provider Quality Review Nurse, RN
Rancho Cucamonga, California, United States
$91k-$121k/yr RemoteFull Time
Inland Empire Health Plan
Inland Empire Health Plan: Public health plan providing managed care to residents.
3+ YOEThree or more years in healthcare quality, QA, utilization management; RN license in California; Nursing bachelor’s degree; CPQH/CPRM or clinical certification preferred; valid CA driver’s license.
Spreadsheets, Databases, Word processing
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1mo
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RN Case Manager - Utilization Review
Lynwood, California, United States
$47-$63/hr OnsiteFull Time
Prime Healthcare
Prime Healthcare: Operates a national network of acute care hospitals.
5+ YOECurrent Ohio RN license, minimum 5 years post-grad nursing experience, 1+ year case management/discharge planning, basic-intermediate computer skills; BCLS required/preferred, CCM preferred, Milliman/InterQual knowledge preferred.
Milliman Criteria, InterQual Criteria
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2mo
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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/hr RemoteFull Time
Molina Healthcare
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.
Microsoft Office, MCG
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2mo
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Outpatient UM Clinician
Sherman Oaks or United States
$36-$48/hr RemoteFull Time
MedPOINT Management
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.
Electronic Health Records (EHR)
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1mo
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Care Manager RN Per Diem Variable
Torrance, California, United States
$57-$89/hr OnsitePart Time
Providence
Providence: Non-profit health system providing comprehensive medical and social services.
2+ YOEAssociate's nursing degree, California RN license, 2 years acute care experience, and 1 year care management or utilization review experience, or completion of a qualifying orientation program.
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1d
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RN, Care Manager (Emergency Dept) (Per diem, Day Shift)
Montebello, California, United States
$58-$79/hr OnsitePart Time
Adventist Health
Adventist Health: Faith-based healthcare provider offering hospital and clinical services.
Required California RN licensure and Hospital Fire and Life Safety certification. BSN, master's degree, and case management, utilization management, or transitional care experience preferred.
InterQual
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3mo
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Case Manager - Care Coordinator - Full Time 8 hours Days (Union, Non-Exempt)
Arcadia, California, United States
$46-$76/hr OnsiteFull Time
Keck Medicine of USC
Keck Medicine of USC: Academic medical system providing specialized healthcare and clinical research.
3+ YOERN with 3+ years in utilization review/discharge planning; CA RN; BLS; associate nursing degree; strong communication and coordination skills.
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3mo
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Case Manager - Care Coordinator - Full Time 8 hours Days (Union, Non-Exempt)
Arcadia, California, United States
$46-$76/hr OnsiteFull Time
Keck Medicine of USC
Keck Medicine of USC: Provides specialized medical care and research via university health system.
3+ YOERN required; 3 years clinical Utilization Review/Discharge Planning preferred; RN license and BLS required; associate nursing degree.
Affinity GUI, InterQual criteria, Electronic Health Record
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3mo
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Case Manager - Care Coordinator - Full Time 8 hours Days (Union, Non-Exempt)
Arcadia, California, United States
$46-$76/hr OnsiteFull Time
University of Southern California
University of Southern California: Private research university providing higher education and healthcare services.
RN required; Associate degree nursing; 3 years utilization review/discharge planning preferred; BLS; strong communication, organization, and analytical skills.
Affinity GUI, Electronic Health Records
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