Utilization Review SpecialistVirtualVocations • Fullerton, California, United States
Utilization Review Specialist
VirtualVocations • Fullerton, California, United States
job_description.job_card.30_days_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_description
A company is looking for a Utilization Review Specialist.
Key Responsibilities
Review and process Independent Review (IR) requests for potential conflicts of interest
Request and organize additional medical documentation for Physician Advisors
Ensure all work meets Client, State, Federal, and URAC compliance standards
Qualifications
High school diploma or equivalent required
Minimum of 1 year in a healthcare-related setting required
Knowledge of HIPAA rules and regulations required
Prior experience in utilization review, medical management, or insurance preferred
serp_jobs.job_alerts.create_a_job
Utilization Review Specialist • Fullerton, California, United States
Job_description.internal_linking.related_jobs
UCLA Health runs and operates over 270 outpatient clinics located in Southern California with over 3,000,000 outpatient encounters annually.
Working under the direction of the Patient Access Organiz...serp_jobs.internal_linking.show_more
Senior Estimate Review Specialist.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the unexp...serp_jobs.internal_linking.show_more
RN – Medical Surgical at Providence St.Mary Medical Center in Apple Valley, CA.This position is Per-Diem and will work 12-hour shifts.
Available shifts may be nights or days.Mary Medical Center, has...serp_jobs.internal_linking.show_more
Reports to Clinical Operations Manager.The Utilization Management Coordinator is responsible for processing and assisting with 80-100 authorizations per day, reviewing authorizations for accuracy s...serp_jobs.internal_linking.show_more
Hybrid Schedule - 3 days remote and 2 on-site (Tues / Thurs).Position Overview • The Utilization Management Specialist plays a critical role within the Quality Management department, serving as the la...serp_jobs.internal_linking.show_more
The Utilization Management (UM) Nurse is responsible for conducting clinical reviews and assessing the medical necessity, appropriateness, and efficiency of healthcare services requested by provide...serp_jobs.internal_linking.show_more
The PACE Utilization Review Specialist – RN oversees clinical utilization management for participants enrolled in the Program for All-Inclusive Care for the Elderly.The position ensures that ...serp_jobs.internal_linking.show_more
AMI Network is partnered with a large healthplan organization to find their next Utilization Management Director in Pasadena.
Our client is a leading Health Plan + IPA that offers full-service Medic...serp_jobs.internal_linking.show_more
Operations Manager - Upland, CA.Would you like to join an international team working to improve the future of healthcare? Do you want to enhance the lives of millions of people? Grifols is a global...serp_jobs.internal_linking.show_more
American Traveler is seeking a travel nurse RN Case Management for a travel nursing job in Los Angeles, California.Job Description & Requirements.
American Traveler is seeking an experienced RN ...serp_jobs.internal_linking.show_more
D-SNP Utilization Management RN.Remote - MUST live in California with active and unrestricted CA license.The Utilization Management (UM) RN for the D-SNP program plays a critical role in ensuring m...serp_jobs.internal_linking.show_more
TravelNurseSource is working with GQR Healthcare to find a qualified Utilization Review RN in San Pedro, California, 90732!.
GQR Healthcare is representing a well-known health system seeking experie...serp_jobs.internal_linking.show_more
A reasonable estimate for this position is $55,000 - $194,800.See Specialist Series - Represented Fiscal Year, Exempt.Specialist Series - Represented Fiscal Year, Non-Exempt.Friday, Aug 8, 2025 at ...serp_jobs.internal_linking.show_more
Inpatient Support Coordinator : .Calling hospitals to verify if patients are still in the hospital or have discharged.Entering and processing hospital face sheets.
Maintaining an updated census for as...serp_jobs.internal_linking.show_more
At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives out of the hospital and in their homes.
We are actively recruiting in ...serp_jobs.internal_linking.show_more
Quality Improvement Specialist at Providence Little Company of Mary Medical Center San Pedro in San Pedro, CA.This position is Full-time and will work 8-hour, Day shifts.
Providence Little Company o...serp_jobs.internal_linking.show_more
Centinela Hospital Medical Center.At Centinela Hospital Medical Center, our dedicated team of professionals are committed to our core values of quality, compassion, and community.As a member of Pri...serp_jobs.internal_linking.show_more
American Traveler is seeking a travel nurse RN Case Management for a travel nursing job in Los Angeles, California.Job Description & Requirements Specialty : Case Management Discipline : RN Start Dat...serp_jobs.internal_linking.show_more TravelNurseSource is working with GQR Healthcare to find a qualified Utilization Review RN in Apple Valley, California, 92307!.
GQR Healthcare is representing a well-known health system seeking expe...serp_jobs.internal_linking.show_more The Utilization Review Nurse is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital, supporting inpatient, partial hospital, and intensive outpatient programs.Per...serp_jobs.internal_linking.show_more
Access Improvement Specialist (Fixed Hybrid)
University of California - Los Angeles Health • Los Angeles, CA, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Senior Estimate Review Specialist
Sedgwick • Glendale, CA, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
RN - Medical Surgical - Per Diem
Providence • Phelan, CA, US
serp_jobs.job_card.part_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
UM Coordinator
Advanced Medical Management • Long Beach, CA, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Utilization Management Specialist
TEKsystems • Los Angeles, CA, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Utilization Management RN
Your IT Recruiter • Los Angeles, CA, us
serp_jobs.job_card.full_time
serp_jobs.filters_job_card.quick_apply
serp_jobs.last_updated.last_updated_variable_days
PACE UTILIZATION REVIEW SPECIALIST - RN
Chinatown Service Center • Alhambra, CA, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Utilization Management Director
Ami Network • Pasadena, CA, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Operations Manager - Upland, CA - $5k Transfer Bonus
Grifols • Upland, CA, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel RN Care Coordinator - Utilization Review
American Traveler • Los Angeles, CA, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
D-SNP Utilization Management RN
Impresiv Health • Long Beach, CA, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
Travel Nurse RN - Utilization Review - $2,134 per week in San Pedro, CA
TravelNurseSource • Los Angeles, California, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Open Positions - Specialist Series
University of California - Irvine • Irvine, CA, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Utilization Management Inpatient Coordinator
Preferred IPA of California • Los Angeles, CA, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Intake Specialist
AdaptHealth • Santa Fe Springs, CA, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
RN - Quality Improvement Specialist
Providence Health and Services • Long Beach, CA, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Director of Case Management - Utilization Management
Prime Healthcare • Inglewood, CA, US
serp_jobs.job_card.full_time +1
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Travel RN Care Coordinator – Utilization Review - $3,167 per week
American Traveler • Textile Finance, CA, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel Nurse RN - Utilization Review - $2,134 per week in Apple Valley, CA
TravelNurseSource • Los Angeles, California, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Utilization Review Nurse
University of California - Los Angeles Health • Los Angeles, CA, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted