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Weekday Insurance Utilization Review Jobs in California

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

Solomon Page

Travel Utilization Review RN

Hayward, CA · On-site

Utilization Review * Discipline: RN * Start Date: 07/27/2026 * Duration: 13 weeks * 40 hours per ... We offer dental insurance to you and your dependents. * Vision Coverage : Available the 1st of the ...

HCS 247

Travel Utilization Review RN

Apple Valley, CA · On-site

Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 40 hours per week ... Accident Insurance * Critical Illness Insurance * Disability Insurance * Term Life Insurance

Solomon Page

Travel Utilization Review RN

Hayward, CA · On-site

Utilization Review * Discipline: RN * Start Date: 08/24/2026 * Duration: 13 weeks * 40 hours per ... We offer dental insurance to you and your dependents. * Vision Coverage : Available the 1st of the ...

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All JobsWeekday Insurance Utilization Review JobsWeekday Insurance Utilization Review Jobs in California

Weekday Insurance Utilization Review information

What is the difference between Weekday Insurance Utilization Review vs Weekday Claims Processor?

AspectWeekday Insurance Utilization ReviewWeekday Claims Processor
Primary RoleAssessing medical necessity and appropriateness of servicesProcessing and reviewing insurance claims for payment
CredentialsOften requires healthcare or insurance certificationsTypically requires insurance or administrative experience
Work EnvironmentHealthcare settings, insurance companiesInsurance companies, healthcare offices
FocusMedical review and authorizationClaims data entry and verification

Weekday Insurance Utilization Review focuses on evaluating medical necessity, while Weekday Claims Processors handle the administrative processing of insurance claims. Both roles are essential in the insurance industry but serve different functions related to claims management and healthcare authorization.

What are the most commonly searched types of Insurance Utilization Review jobs in California? The most popular types of Insurance Utilization Review jobs in California are:
What cities in California are hiring for Weekday Insurance Utilization Review jobs? Cities in California with the most Weekday Insurance Utilization Review job openings:
Weekday Insurance Utilization Review jobs near you
Utilization Review RN (Hybrid)

Utilization Review RN (Hybrid)

Vivo HealthStaff

Daly City, CA • On-site

Full-time

Re-posted yesterday

Job description

Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan in San Francisco. It is a hybrid position with 1-2 days per week on-site required.

Collaborates with the physician, nurse case manager, social worker, and other members of the health care team to meet individualized patient outcomes. Performs concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Ensures medical necessity determinations, service authorization and concurrent denials are managed effectively and financially responsibly.

Education

    • Valid RN license in State of California
    • Bachelor's degree in Nursing

Experience

      • Clinical experience in acute care setting Required
      • Experience with interqual and millimen Preferred

Licenses and Certifications

        • CPR - Cardiac Pulmonary Resuscitation CPR/BLS Preferred and
        • CCM - Certified Case Manager CCM Preferred and
        • ACMA Preferred

Knowledge, Skills, and Abilities

        • Verbal and written communication skills.
        • Basic computer skills.
        • Diagnostic and problem-solving skills.
        • Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
        • Actively participates in ongoing professional enrichment and educational opportunities. Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high quality, cost effective manner. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient, LOS insurance and discharge needs.
        • Collects quality improvement data in accordance with approved indicators. Recognizes potential problems and makes referrals to quality improvement, risk management, safety, infection control, and other departments as appropriate.
        • Confers and collaborates routinely with the physician advisor, division chiefs, and attending physicians to resolve problems regarding acuity and level of care.
        • Evaluates concurrent and retrospective denials for appeal opportunities. May generate appeal letters based on knowledge of clinical severity and intensity.
        • Identifies insurance information, obtains authorization, communicates with financial counseling and assigns appropriate length of stay for admission.
        • Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third party payers according to policies and procedures. Communicates utilization plans to case management team.
        • Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment for services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources.
        • Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services, staff meetings, orientation and formal educational offerings.
        • Demonstrates knowledge of the dynamics of abuse/neglect, including identification and reporting laws. Coordinates with investigating law enforcement, protection agencies, hospital security, risk management, and healthcare team. Demonstrates knowledge of community resources serving the high social risk populations.
        • Performs other duties as assigned.
Vivo HealthStaff logo

About Vivo HealthStaff

Sourced by ZipRecruiter

Vivo HealthStaff provides permanent recruitment services for both clinical and administrative positions in the healthcare sector. Over the past 2 years, our clients have seen a 98% retention rate with Vivo HealthStaff placements.

Industry

Health care and social assistance

Company size

11 - 50 Employees

Headquarters location

Dublin, CA, US

Year founded

2016

Social media

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