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26 utilization nurse jobs at 13 companies in San Jose, CA

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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5d
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Utilization Review Coordinator
San Jose, California, United States
$195k-$249k/yr FieldTemporary
County of Santa Clara
County of Santa Clara: Provides public services and healthcare to Santa Clara County residents.
2+ YOECurrent unrestricted California RN license and two years of recent acute-care hospital nursing experience; utilization review experience is desirable.
InterQual, Milliman Care Guidelines (MCG)
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2w
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Utilization Specialist - Full Time
San Jose, California, United States
$33-$60/hr OnsiteFull Time
Acadia Healthcare
Acadia HealthcareNasdaq: ACHC: Provider of inpatient and outpatient behavioral health services.
Associate degree in nursing required (LPN/LVN/RN) or relevant behavioral health degree preferred; clinical license (LMFT/LMSW/LCSW/LPC/LPC-I) or equivalent; CPR and de-escalation/restraint certification; utilization management experience preferred.
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1w
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Wound Care Utilization Management RN
Indianapolis or Iselin or Tampa or Miami or Wilmington or Cincinnati or St. Louis or Walnut Creek or Las Vegas or Woburn or Grand Prairie or Chicago or California or Illinois or Massachusetts or Nevada or New Jersey
$39-$56/hr RemoteFull Time
Elevance Health
Elevance HealthNYSE: ELV: Provides health insurance plans and integrated healthcare services.
3+ YOERequires an associate degree in nursing or equivalent background, 3+ years of healthcare experience, active unrestricted RN license, and wound-care certification such as WOCN or CWS.
medical records
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1mo
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Utilization Management and Discharge Planning RN
San Jose, California, United States
$99k-$148k/yr OnsiteFull Time
Santa Clara Family Health Plan
Santa Clara Family Health Plan: Provides managed health insurance plans for Santa Clara County residents.
1+ YOEActive California RN license, 1+ year licensed healthcare experience, knowledge of utilization management and discharge planning, proficiency with Outlook/Word/Excel, strong clinical judgment and communication.
Outlook, Word, Excel
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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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1mo
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RN - Case Manager - CMC - AS Utilization Management - Part Time - 8 Hour - Days
Concord, California, United States
$89-$122/hr OnsitePart Time
John Muir Health
John Muir Health: Operates integrated hospital networks and outpatient medical centers.
2+ YOEActive California RN license, BLS required, ACM or CCM preferred; 2–3 years nursing/case management experience preferred; knowledge of Medicare/Medi-Cal, utilization rules, and care coordination; strong communication and computer skills.
EPIC, Allscripts, InterQual, Microsoft Outlook
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1w
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Case Manager II, Registered Nurse
Burlingame, California, United States
$91-$127/hr OnsitePart Time
Sutter Health
Sutter Health: Operates an integrated network of hospitals and medical clinics.
5+ YOEGraduate of an accredited nursing school with a California RN license and five years of recent relevant experience. Requires case management, utilization review, communication, negotiation, teamwork, and intermediate technology skills.
CMS, Title 22, CDPH, TJC, HMO, PPO, PPS, DRG
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3w
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Case Manager I
Mountain View, California, United States
$94-$123/hr OnsitePart Time
El Camino Health
El Camino Health: Providing acute care and medical services through community hospitals.
Bachelor's in nursing and current California RN license required; case management experience and CCM/ACM preferred; strong communication, advocacy, utilization management, and computer skills.
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6d
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Case Manager II - FT Days
San Francisco, California, United States
$65-$82/hr OnsiteFull Time
ScionHealth
ScionHealth: Operates community and specialty hospitals providing acute healthcare services.
2+ YOEHealthcare professional licensure as an RN, LCSW, or LSW; accredited program graduate; two years of healthcare experience preferred. Case management, utilization review, or discharge planning experience preferred.
Microsoft Office
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1mo
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Case Manager (RN) - Inpatient - 1.0 FTE, 08-HR, Day Shift
Palo Alto, California, United States
$96-$111/hr OnsiteFull Time
Stanford Health Care
Stanford Health Care: Provides comprehensive medical care, specialized treatments, and clinical research.
3+ YOECA RN license required, Bachelor's degree required (Master's preferred), 3 years related experience, expertise in discharge planning, utilization review, care coordination, and third-party reimbursement.
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3w
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Case Manager - Physical Rehabilitation
San Francisco, California, United States
OnsiteFull Time
UCSF Health
UCSF Health: Academic medical center providing advanced patient care and research.
Provides case management and complex discharge planning for a designated caseload; requires bachelor\u0002s in healthcare, RN license in California, BLS, case management/utilization review experience, EMR proficiency, strong communication and analytic skills.
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1w
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ASSOCIATE MEDICAL DIRECTOR
Livermore, California, United States
$250k-$260k/yr OnsiteFull Time
Axis Community Health
Axis Community Health: Providing affordable medical, dental, and mental healthcare services.
2+ MgmtMD, DO, or advanced nursing degree with primary care board certification; California physician or nurse practitioner license; 2+ years managerial experience; healthcare quality, utilization, and clinical leadership expertise.
Microsoft Office, Epic Electronic Medical Records (EMR)
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