Utilization Review Nurse jobs in Los Angeles, CA

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RN - Utilization Review - Case Manager
Providence Health & Services - 953 reviews - Mission Hills, CA 91346
California State Registered Nurse License. Providence is calling a Utilization Review RN Case Manager ( Full Time / Day Shift ) at our Providence Medical...
Registered Nurse (RN)
Arroyo Vista Family Health Center - Los Angeles, CA 90042
Registered Nurse (RN). Performs nursing electronic health record (EHR) documentation reviews to assure compliance with EHR documentation policy and procedures....
Director Case Management RN FT
A) manage department operations to assure effective throughput and reimbursement for services provided, b) lead the implementation and oversight of the hospital...

Sr. Retrospective review nurse (Remote)

Alvarez & Marsal - 27 reviews - Los Angeles, CA 90071
Perform utilization management, utilization review or concurrent review and Retrospective reviews leveraging Interqual guidelines and benefit determination....

Medical Claims Review Nurse RN

UnitedHealth Group - 9,473 reviews - Los Angeles, CA 90079
Background involving utilization review for an insurance company or experience in case management. Perform clinical coverage review services, which require...

Nurse Reviewer I (Utilization Review) - AIM, Glendale CA

Anthem, Inc. - 2,429 reviews - Glendale, CA 91205
Nurse Reviewer I position:. Familiarity with Utilization Management Guidelines preferred. Nurse Reviewers are responsible for conducting pre-authorization, out...

Electrophysiology Case Manager-RN

Kaiser Permanente - 5,802 reviews - Los Angeles, CA
Will provide support for the Physicians, ICD nurses and EP Lab nurses in coordinating care and resolving problems....

Outside Care Clinic Reviewer RN

Kaiser Permanente - 5,802 reviews - Pasadena, CA
Profiling of non-plan providers, utilization patterns, direct interaction with providers to discuss, review and query services provided, charges and/or expenses...

Medical Claim Review Nurse

Molina Healthcare - 650 reviews - Long Beach, CA
Minimum one year Utilization Review and/or Medical. Assists with Complex Claim review; Documents clinical review summaries, bill audit findings and audit...

Clinical Utilization Review Nurse

NS and Associates - Brea, CA
The Clinical Utilization Review Specialist is responsible for performing clinical reviews, prior authorization reviews, and protocol development under the...
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REGISTERED NURSE II (CORRECTIONAL HEALTH)

Los Angeles County Human Resources - Los Angeles County, CA
$77,362 - $112,702 a year
Participating in conducting prospective, concurrent, and retrospective utilization reviews of patient services or hospitalization to maintain quality of care...

Utilization Management Registered Nurse

AIDS Healthcare Foundation - 115 reviews - Los Angeles, CA
Organizational determinations, reconsiderations, expedited reviews, Independent Review Entity (IRE) reconsiderations, QIO review of coverage terminations,...

Registered Nurse

Arroyo Vista Family Health Center - 12 reviews - Los Angeles, CA
Performs nursing electronic health record (EHR) documentation reviews to assure compliance with EHR documentation policy and procedures....
Nurse Manger - Telephone Triage
City of Hope - 147 reviews - Irwindale, CA 91010
Telephone Triage Nurse Manager. And functions as primary resource for nurse triage team members. Under the Contact Center Director, the Manager of the Nurse...
Utilization Review Nurse
Kedren Community Health Center Inc - Los Angeles, CA 90002
Minimum of one year experience performing the duties of a Utilization Review Nurse or Medical Service Coordinator....
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