Utilization Review Nurse jobs in Palo Alto, CA

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RN Field Nurse/Case Manager
Excel Managed Care & Disability Services, Inc. - San Jose, CA
Excel Managed Care & Disability Services (Excel) provides Occupational & Non-Occupational Medical Case Management, Utilization Review and Return-to-Work...
Desired Experience: Case Manager Certification, Time Management, RN, Microsoft Office, Driver's License, Managed Care
Easily apply
Peer Review Coordinators- RN req'd
Lumetra Healthcare Solutions - San Francisco, CA
In applicable cases, perform case review utilizing InterQual criteria and clinical knowledge for medical necessity and quality of care issues and coordinate...
Desired Experience: RN, Microsoft Powerpoint, Quality Management
Easily apply
Quality Specialist - Clinical Effectiveness & Analysis (1.0...
Gathers and analyzes clinical and financial information from a variety of internal and external sources, relating to patient safety, utilization of resources...
Desired Experience: RN
Quality Improvement Manager - Valley Health Plan
The County of Santa Clara - Valley Health Plan - San Jose, CA
Under direction to plan, develop, implement, and coordinate the operation of the Quality Management/Risk Management (QM/RM), Utilization Management (UM) and...
Desired Experience: RN, Driver's License, Managed Care

Utilization Management Review Nurse (LVN)

Santa Clara Family Health Plan - 14 reviews - Campbell, CA 95008
$27.86 - $41.79 an hour
Under the guidance and direction of the UM department RN Manager or Director, the Utilization Management Review Nurse (LVN) performs prospective and...
Desired Experience: RN, Managed Care

Utilization Management & Discharge Planning Nurse

Santa Clara Family Health Plan - 14 reviews - Campbell, CA 95008
$36.85 - $55.27 an hour
Planning Nurse performs clinical review in accordance with applicable regulatory and professional standards for Organization Determination Requests using...
Desired Experience: RN, Clean Driving Record, Driver's License, Managed Care

Quality Management Nurse

Dignity Health Management Services Organization - 936 reviews - Redwood City, CA
Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and...
Desired Experience: RN, Process Improvement, Quality Management, Managed Care

Case Management Nurse (Open)

County of San Mateo - 122 reviews - San Mateo County, CA
$57.50 - $67.98 an hour
Advanced principles and practices in specialty areas; Nurse Practice Act; current nursing and related medical theory and skills necessary to administer...
Desired Experience: Case Management, BLS Certification, RN

185 CASE & DISEASE MGMT - Nurse Liaison for Community Care M...

Alameda Alliance - 4 reviews - Alameda, CA 94502
$77,710 - $116,570 a year
Work closely with the Alliance Case Management Managers, Medical Directors, Social Workers, Community Health Workers, and other Alliance staff involved in...
Desired Experience: Certified Nurse Practitioner, Case Management, RN, Microsoft Powerpoint, Behavioral Health, Microsoft Word, Managed Care
Easily apply

Case Manager

Good Samaritan Hospital - 153 reviews - San Jose, CA
She/he provides direct service to patients and their families for emotional support, education, and information regarding community resources and discharge...
Desired Experience: RN

Nurse Auditor Charg&ContrCompl - Corp Compliance

El Camino Hospital-Mountain View Campus - 97 reviews - Mountain View, CA
Understands the role and importance of proper registration, billing, charge compliance, contracting, utilization review and account follow-up in meeting the...
Desired Experience: RN

235 QUALITY IMPROVEMENT - Sr Qlty Improv Nurse Spclst

Alameda Alliance - 4 reviews - Alameda, CA 94502
$89,360 - $134,050 a year
Use clinical experience and judgment when using a medical record audit tool to measure provider compliance with medical record standards pertaining to...
Desired Experience: RN, NCQA Standards, Microsoft Office, Managed Care
Easily apply

UM Prior Authorization/Case Manager Nurse

Alameda Health Consortium/Community Health Center... - San Leandro, CA
The position supports CHCN goals to ensure the appropriate utilization and management of the organizations’ resources. This position will identify, screen...
Desired Experience: RN, LVN, Medical Terminology, Managed Care

Quality Improvement Coordinator

Santa Clara Family Health Plan - 14 reviews - Campbell, CA 95008
$24.77 - $37.15 an hour
Coordinate health education programs, including the scheduling of meetings with community partners, preparing of packets for health education outreach, and...
Desired Experience: Driver's License, Managed Care
Utilization Review Nurse (RN)
AMT Staffing Solutions LLC. - San Francisco, CA
The primary responsibility of the utilization review nurse- review medical records and prepare clinical appeals (when appropriate) on medical necessity...
Desired Experience: RN
Easily apply
Nurse Auditor Charg&ContrCompl - Corp Compliance
Understands the role and importance of proper registration, billing, charge compliance, contracting, utilization review and account follow-up in meeting the...
Desired Experience: RN