Utilization Review Nurse jobs in Redwood City, CA

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Outpatient Utilization Management Nurse
The Outpatient Utilization Management (UM) Nurse is responsible for conducting clinical reviews of outpatient authorization requests....

Outpatient Utilization Management Nurse

Alameda Alliance for Health - 16 reviews - Alameda, CA
The Outpatient Utilization Management (UM) Nurse is responsible for conducting clinical reviews of outpatient authorization requests....

Prior Authorization Nurse (Temp)

Alameda Health Consortium/Community Health Center... - San Leandro, CA
UM Prior Authorization (PA) Nurse. This position supports CHCN’s Medical Directors with case review prep including medical review criteria for PA determinations...

Nurse, Care Management

Alameda Health System - 38 reviews - Oakland, CA
Coordinates all utilization review functions, including response to payor requests for concurrent and retrospective review information including Medicare and...


ST. ROSE HOSPITAL - 31 reviews - Hayward, CA 94545 (Glen Eden area)
 Tracks and monitors inappropriate resource utilization. As part of the team, makes decisions regarding utilization management and alternative treatment which...

Outpatient Case Management RN

Alameda Health Consortium/Community Health Center... - San Leandro, CA
Active, unrestricted, California Nursing License (Registered Nurse). Identify barriers to efficient hospital utilization and facilitate resolution....

Utilization Management RN Manager

Clover Health - San Francisco, CA
2-3 years experience in a hospital setting, acute care, direct care experience preferred OR experience as case manager, care coordinator, concurrent review...

Case Manager/Care Manager (RN)

Seton Medical Center - 6 reviews - Daly City, CA
One year case management or utilization review experience preferred. Current and Valid License in the State of California as a Registered Nurse....

Case Manager

University of California San Francisco Medical Cen... - 201 reviews - San Francisco, CA
Recent experience in case management, utilization review or discharge planning. Active Registered Nurse licensure in the State of California....

Care Manager ASOC Program (CA Only)

California Health & Wellness - 436 reviews - Oakland, CA
Needs identification, development and implementation of improved utilization management, referral review, and quality improvement....

Nurse Manager (Quality Management)

Zuckerberg San Francisco General Hospital and Trau... - San Francisco Bay Area, CA
Nurse Quality, Utilization or Improvement Management:. Coordinates Utilization Reviews with both internal and external stakeholders utilizing InterQual Criteria...
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Inpatient Utilization Management Nurse
The Inpatient Utilization Management (UM) RN is responsible for conducting on-site and telephonic utilization review of hospitalized members and initiating the...
Clinical Documentation Improvement Specialist - $5K Sign on...
UnitedHealth Group - 5,373 reviews - San Francisco, CA
Provides expert level review of inpatient clinical records within 24-48 hours of admit; Ensures effective utilization of Midas or Optum ® CDI 3D Technology to...
Utilization Review Specialist- Oakland, CA
BHR Corporation - Oakland, CA
The Utilization Review Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according...
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