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From Home Utilization Management Jobs in California

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All JobsUtilization Management JobsFrom Home Utilization Management JobsFrom Home Utilization Management Jobs in California

From Home Utilization Management information

What is the difference between From Home Utilization Management vs From Home Case Management?

AspectFrom Home Utilization ManagementFrom Home Case Management
CertificationsCPUR, CCM, or similarCPUR, CCM, or similar
Work EnvironmentRemote, healthcare insurance companiesRemote, healthcare insurance companies
Primary FocusReviewing medical necessity and resource utilizationCoordinating patient care and services
Employer UsageHealth insurers, managed care organizationsHealth insurers, managed care organizations

From Home Utilization Management primarily focuses on evaluating medical necessity and resource utilization, ensuring appropriate healthcare services. In contrast, From Home Case Management emphasizes coordinating patient care and services to support health outcomes. Both roles are remote, require similar certifications, and are used within healthcare insurance companies, but their core responsibilities differ.

What are the most commonly searched types of Utilization Management jobs in California?

The most popular types of Utilization Management jobs in California are:

From Home Utilization Management jobs near you

Utilization Management Clinical

Chico, CA • On-site

Butte Home Health & Hospice
Health Care and Social Assistance • 51 - 200 employees
Learn more about Butte Home Health & Hospiceexternal

$50 - $60/hr

Other

Posted 25 days ago

Job description

Utilization Management Clinical

Office - Chico, CA 95973

Overview

Salary Range $50.00 - $60.00 Hourly Position Type Full Time Job Shift Day Education Level Professional License Required Category Health Care

Description

The Utilization Manager, Registered Nurse, is an office-based nursing position responsible for supporting high-quality patient care through clinical oversight, utilization management, and real-time guidance to field clinicians. This role serves as a key clinical resource within the organization, assisting with nursing calls, care coordination, and clinical decision-making to promote positive patient outcomes while ensuring regulatory and payer compliance.

Key responsibilities include:

  • Provide clinical support and guidance to field clinicians, including RNs, LVNs, and therapy staff.
  • Take and triage nursing calls from clinicians, patients, and caregivers as appropriate.
  • Collaborate with field staff to assist with clinical problem-solving, patient status changes, and care planning.
  • Review plans of care and clinical documentation to ensure appropriate utilization of services and skilled need.
  • Monitor visit frequencies and service utilization in alignment with physician orders, payer guidelines, and agency standards.
  • Support case managers with recertifications, discharges, transitions of care, and care coordination.
  • Participate in interdisciplinary collaboration to promote continuity of care and effective communication.
  • Identify clinical risks or concerns and escalate issues appropriately.
  • Support compliance with Medicare Conditions of Participation, regulatory requirements, and agency policies.
  • Contribute to quality improvement initiatives focused on patient outcomes, documentation accuracy, and clinical best practices.
Qualifications

Required Qualifications

  • Active Registered Nurse (RN) license in the state of California.
  • Strong clinical assessment, critical-thinking, and decision-making skills.
  • Excellent verbal and written communication skills.
  • Ability to work collaboratively with interdisciplinary teams.
  • Proficiency with electronic medical records (EMR) systems and basic computer applications.

Preferred Qualifications

  • Experience in utilization management, case management, or clinical coordination.
  • Home Health experience preferred but not required.
  • Knowledge of Medicare home health regulations, payer guidelines, and Conditions of Participation.
  • Experience providing clinical support, education, or mentorship to field clinicians.
  • Strong organizational skills with the ability to manage multiple priorities in a fast-paced office environment.

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