1854 Utilization Review jobs in California

At least 7 years experience in health care, and at least 3 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
At least 1 year of health care management/leadership experience.
Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW).
Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
Experience working within applicable state, federal, and third party regulations.
Demonstrated knowledge of community resources.
Proactive and detail-oriented.
Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
Ability to work independently, with minimal supervision and demonstrate self-motivation.
Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
Excellent problem-solving and critical-thinking skills.
Excellent verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

SmartExplore AI is experimental.

New, Posted 19 hours ago

Recommended

Easy Apply

Customer Service Enrollment Specialist - Remote

Hire Standard Staffing

all cities, CA

$120,000/yr

RemoteHealth Insurance

Must be a U.S. or Canadian citizen

SmartExplore AI is experimental.

Recommended

Manager, Healthcare Services - Remote (Must Reside in California)

Molina Healthcare

Imperial Beach, CA 91932

$84,067-$163,931/yr

Remote

At least 7 years experience in health care, and at least 3 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
At least 1 year of health care management/leadership experience.
Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW).
Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
Experience working within applicable state, federal, and third party regulations.
Demonstrated knowledge of community resources.
Proactive and detail-oriented.
Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
Ability to work independently, with minimal supervision and demonstrate self-motivation.
Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
Excellent problem-solving and critical-thinking skills.
Excellent verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

SmartExplore AI is experimental.

New, Posted 1 day ago

Recommended

Apply Directly

Document Review Manager

KPMG

San Francisco, CA 94112

OnsiteHealth InsuranceRetirement Benefit

Minimum five years of recent experience as a review manager in the legal industry
Juris Doctorate Law Degree from an accredited college or university is required; a license to practice law in the U.S. is required.
Relativity Certified Administrator preferred; experience with Reveal/Brainspace and Relativity Analytics
Applicants must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future; KPMG LLP will not sponsor applicants for U.S. work visa status for this opportunity (no sponsorship is available for H-1B, L-1, TN, O-1, E-3, H-1B1, F-1, J-1, OPT, CPT or any other employment-based visa)
Master's degree from an accredited college or university is required.

SmartExplore AI is experimental.

Apply Directly

Claim Specialist - Property Field Inspection

State Farm

Santa Monica, CA 90401

$64,965.62-$111,595/yr

RemoteFlexible ScheduleEducation AssistanceHealth InsurancePaid Time OffRetirement Benefit

A valid driver's license is required
Experience as a Property Field Inspection Claim Specialist in the insurance industry, specifically in property claims
Strong knowledge of property insurance policies, coverage and claim handling practices
Knowledge of both residential and commercial building construction
Familiarity with local regulations and compliance requirements in your assigned territory
Excellent communication and interpersonal skills to effectively interact with clients, agents, and other stakeholders
Proven effective communication skills to handle difficult/emotional conversations with a customer-minded focus
Proven ability to assess damages, estimate repair costs, and negotiate settlements
Detail-oriented with strong organizational and analytical skills
Proficient in using claims management software and other relevant tools
Physical agility to allow for: frequent lifting, carrying and climbing a ladder; ability to navigate roofs at various heights for inspection of both residential and commercial structures; ability to crawl in tight spaces
May be required to complete Rope and Harness Safety Training
Employees must successfully complete all required training, including applicable licensing exam(s), Motor Vehicle Record (MVR) checks, and background checks required of various state(s)

SmartExplore AI is experimental.

Recommended

Apply Directly

Admissions Representative

Sierra Health and Wellness Centers

Oroville, CA 95965

$24-$30/hr

Onsite

Possess High School diploma or GED equivalent.
Familiar with HIPAA/client confidentiality and personal rights.
Possess CPR/First Aid certification.
Current TB test and health screen
Valid Driver's License

SmartExplore AI is experimental.

New, Posted 10 hours ago

Easy Apply

Accounts Payable Specialist

LHH US

Lemon Grove, CA 91945

$26.44-$28.41/hr

HybridHealth InsurancePaid Time OffRetirement Benefit

3+ years of recent accounts payable experience
In a manufacturing, distribution, logistics, industrial, or similarly fast-paced environment
Experience processing large volumes of invoices
Managing multiple priorities simultaneously
Strong understanding of invoice matching, vendor management, and payment processing
Proficiency in Microsoft Excel, including the ability to work with spreadsheets, formulas, and reporting functions
Excellent attention to detail with strong organizational and problem-solving skills
Ability to communicate professionally with vendors and internal stakeholders
Self-motivated, dependable, and capable of working independently while contributing to a team environment
Hybrid role working 3 days a week in office

SmartExplore AI is experimental.

New, Posted 16 hours ago

Recommended

Easy Apply

Quality/Risk Director

Encompass Health Rehabilitation Hospital of Modesto

Modesto, CA 95355

OnsiteEducation AssistanceHealth InsurancePaid Time OffRetirement Benefit

A bachelor's degree in healthcare or a related field is preferred.
License or Certification as required by state regulations.
Experience in Quality and/or Risk Management, including primary responsibility for performance improvement activities, regulatory compliance, conflict resolution, leadership, and risk management activities.

SmartExplore AI is experimental.