Utilization Management Nurse, Senior
Blue Shield of California · El Dorado Hills, California
Posted Oct 7, 2026 · Verified open Oct 10, 2026
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The Utilization Management team independently manages complex utilization and retrospective clinical reviews across multiple lines of business, assessing medical necessity, coding accuracy, treatment plans, discharge planning, and compliance requirements while supporting clinical consistency, process improvement, quality, timeliness, and appropriate escalation of high-risk cases.