Utilization Management Nurse, Senior

2 weeks ago

San Diego, CA, United States Blue Shield of CA Full time

Your Role

The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the facilities to determine medical necessity when our members admit. You will also be involved with discharge planning and transfers as needed for higher levels of care or out of network admissions.

Your Knowledge and Experience

  • Bachelors of Science in Nursing or advanced degree preferred.
  • Requires a current California RN License
  • Requires at least 5 years of prior relevant experience
  • Requires strong communication and computer navigation skills
  • Desires strong teamwork and collaboration skills
  • Requires independent motivation and strong work ethic
  • Requires strong critical thinking skills

  • Utilization Management Nurse Director

    1 week ago

    San Francisco, CA, United States Clinical Management Consultants Full time

    The Utilization Management Nurse Director opportunity delivers a leadership launchpad in a dynamic Bay Area hospital, uniting mission-driven care with performance excellence and innovation. The Utilization Management Nurse Director will step into a high-visibility role shaping patient flow, value-based care, and quality outcomes. The Utilization Management...

  • Utilization Management Nurse Director

    1 day ago

    San Francisco, CA, United States Clinical Management Consultants Full time

    The Utilization Management Nurse Director opportunity delivers a leadership launchpad in a dynamic Bay Area hospital, uniting mission-driven care with performance excellence and innovation. The Utilization Management Nurse Director will step into a high-visibility role shaping patient flow, value-based care, and quality outcomes. The Utilization Management...

  • Utilization Management Nurse Director

    2 weeks ago

    San Francisco, CA, United States Clinical Management Consultants Full time

    The Utilization Management Nurse Director opportunity delivers a leadership launchpad in a dynamic Bay Area hospital, uniting mission-driven care with performance excellence and innovation. The Utilization Management Nurse Director will step into a high-visibility role shaping patient flow, value-based care, and quality outcomes. The Utilization Management...

  • Utilization Management Nurse Director

    3 days ago

    San Francisco, CA, United States Clinical Management Consultants Full time

    The Utilization Management Nurse Director opportunity delivers a leadership launchpad in a dynamic Bay Area hospital, uniting mission-driven care with performance excellence and innovation. The Utilization Management Nurse Director will step into a high-visibility role shaping patient flow, value-based care, and quality outcomes. The Utilization Management...

  • Senior Critical Utilities Manager

    3 days ago

    San Diego, CA, United States synerG Full time

    COMPANY DESCRIPTION: A career here is life-enhancing. At Syner-G, we enable our people to build careers that impact positively on their quality of life. Through our expertise, insight, consulting and management skills, we accelerate breakthrough science and delivery of life-enhancing therapies to more patients. We work across a diverse range of clients and...

  • Medication Nurse

    1 day ago

    San Diego, CA, United States Oakmont Senior Living Full time

    Position: Medication Nurse, LVN / LPN - Assisted Living and Memory CarePart timePay Range: $34-36IVY PARK AT LA JOLLA is a premier senior living community situated on a beautifully landscaped campus. Managed by Oakmont Management Group,we provide exceptional quality, comfort, and care with five-star services and amenities. Residents enjoy a rewarding...

  • Medication Nurse

    5 days ago

    San Diego, CA, United States Oakmont Senior Living Full time

    Position: Medication Nurse, LVN / LPN - Assisted Living and Memory CarePart timePay Range: $34-36IVY PARK AT LA JOLLA is a premier senior living community situated on a beautifully landscaped campus. Managed by Oakmont Management Group,we provide exceptional quality, comfort, and care with five-star services and amenities. Residents enjoy a rewarding...

  • Medication Nurse

    1 week ago

    San Diego, CA, United States Oakmont Senior Living Full time

    Position: Medication Nurse, LVN / LPN - Assisted Living and Memory CarePart timePay Range: $34-36IVY PARK AT LA JOLLA is a premier senior living community situated on a beautifully landscaped campus. Managed by Oakmont Management Group,we provide exceptional quality, comfort, and care with five-star services and amenities. Residents enjoy a rewarding...

  • Medication Nurse

    2 weeks ago

    San Diego, CA, United States Oakmont Senior Living Full time

    Position: Medication Nurse, LVN / LPN - Assisted Living and Memory CarePart timePay Range: $34-36IVY PARK AT LA JOLLA is a premier senior living community situated on a beautifully landscaped campus. Managed by Oakmont Management Group,we provide exceptional quality, comfort, and care with five-star services and amenities. Residents enjoy a rewarding...

  • Medication Nurse

    2 weeks ago

    San Diego, CA, United States Oakmont Senior Living Full time

    Position: Medication Nurse, LVN / LPN - Assisted Living and Memory CarePart timePay Range: $34-36IVY PARK AT LA JOLLA is a premier senior living community situated on a beautifully landscaped campus. Managed by Oakmont Management Group,we provide exceptional quality, comfort, and care with five-star services and amenities. Residents enjoy a rewarding...