789 utilization jobs at 264 companies in Rancho Cucamonga, CA
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Utilization Clerk
Corona, California, United States
$23-$26/hrHybridFull Time
A&S Management: Operates social service programs and real estate for developmental disabilities.
1+ YOEHigh school/GED,1+ year admin/scheduling or data-entry experience (healthcare preferred),bilingual English/Spanish,proficient with Microsoft Office and EHR,valid driver's license and reliable transportation,HIPAA compliance and attention to detail.
Prime Healthcare: Operates acute care hospitals and outpatient facilities in the US.
7+ YOERequires current state RN license, BCLS/BLS (AHA), knowledge of MCG or InterQual, minimum 7 years post-graduate nursing and 3+ years utilization review experience; strong clinical judgment and computer skills.
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.
AltaMed: Provides comprehensive healthcare services to underserved Southern California communities.
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.
Acadia HealthcareNasdaq: ACHC: Operates specialized psychiatric and addiction treatment centers.
2+ YOEClinical experience (2+ years preferred), high school diploma or equivalent, preferred clinical licensure (LPN/RN/LMSW/LCSW/LPC/LPC-I), CPR and de-escalation/restraint certifications.
Redlands Community Hospital: Provides comprehensive medical, surgical, and emergency healthcare services.
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.
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
KPC Health: Operates a network of hospitals and diagnostic laboratories.
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
View Behavioral Health: Provides inpatient and outpatient psychiatric and behavioral health care.
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
Molina HealthcareNYSE: MOH: Provides managed health insurance through government-sponsored benefit programs.
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.
Alignment HealthNASDAQ: ALHC: Provides Medicare Advantage plans and coordinated clinical services for seniors.
5+ YOE5+ years nursing in managed care/utilization review; RN or LPN license; Bachelor’s in Nursing/Health or Education; experience in clinical training.
Providence: Provides comprehensive healthcare services through hospitals, clinics, and health plans.
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.
Providence: A non-profit health system providing comprehensive medical care services.
2+ YOEAssociate's Degree in Nursing, California RN license upon hire, 2 years UR or acute hospital case management experience, knowledge of utilization management and medical necessity, strong communication and decision-making skills.
Cerritos or California or Nevada or Arizona or Oregon or Florida
$275k-$325k/yrRemoteFull Time
The Oncology InstituteNASDAQ: TOI: Provides medical oncology, hematology, and clinical trial services.
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.
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.
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/yrHybridFull Time
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.
Kaiser Permanente: Provides integrated medical care and health insurance plans.
2+ YOECalifornia RN license, BLS, accredited RN training, and two years of combined acute care or case management experience required; utilization review, discharge planning, case management, computer literacy, and communication skills required.
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
AMFM Healthcare: Providing residential and outpatient mental health treatment services.
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.