Nurse Auditor - Utilization Management & Denial Analytics
University of California - Los Angeles Health
University of California - Los Angeles Health is seeking an Utilization Management Nurse Auditor to provide clinical review, audits, and quality improvement support across the health system. You will conduct concurrent and retrospective reviews, support denials appeals, and analyze trends to drive utilization performance. The role requires a California RN license, 5+ years in healthcare, and strong knowledge of payment and audit processes. #J-18808-Ljbffr University of California - Los Angeles Health
$98.2k - $214.6k
...Services Provide clinical review, audit, analytical, and quality improvement support for utilization management, medical necessity determinations, and denial prevention and response efforts... .... As the Utilization Management Nurse Auditor, you will conduct concurrent and...Suggested- UCLA Health is seeking an Utilization Management Nurse Auditor in Los Angeles to support clinical review, audit, and quality improvement across the health system. The role conducts concurrent and retrospective reviews, supports appeals, analyzes utilization trends, and...Suggested
$65.8k - $130.8k
...Duties and Responsibilities The UM Denial Nurse Reviewer supports high-quality,... ...licensure required Two or more years of utilization review/utilization management experience in an HMO, MSO, IPA, or... ...communication, interpersonal, analytical, problem-solving, organizational,...SuggestedRemote workMonday to FridayFlexible hours- ...Health Services Corp. in Montebello, CA is seeking a Nurse Auditor for Delegation Oversight to perform audits ensuring delegates... ...CA nursing license (RN or LVN), with 3+ years in managed care, 2+ years in utilization management, and BLS certification. #J-18808-Ljbffr...Suggested
$88.85k - $142.17k
...purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for... ...processes, helps reduce unnecessary denials, and monitors for potential fraud... ...skills. Preferred: Strong analytical and investigative skills with the...SuggestedFull time$70k - $80k
...NKSFB, LLC is the largest business management firm in the country, with more than 65... .... We are seeking a Senior Staff Auditor to be a key contributor in our Audit Department... ...throughout the audit process. Utilize data analytics and computer-assisted audit techniques...Summer workWork at officeFlexible hours$60 - $75 per hour
...Utilization Management NurseWe are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role...Work at officeFlexible hours$60 - $75 per hour
...Utilization Management Nurse We are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your...Hourly payWork at officeFlexible hours- ...Job Description Job Description Job Description: Manager of Clinical Utilization Management - Denial Compliance Location: Burbank, CA Position Type... ...: 1. Graduate from an accredited Registered Nursing Program; RN preferred. 2. Minimum of five years in...Permanent employmentFull timeTemporary workRemote workFlexible hours
- ...Job Description Job Description About the Role Join myPlace Health as a Registered Nurse - Utilization Management in Los Angeles, CA. myPlace Health specializes in providing value-based, comprehensive care and coverage for older adults with significant needs, enabling...Full time
- ...insurance Wellness resources About the Role: MedPOINT Management is looking for a detail-oriented Claims Auditor to join our team in Sherman Oaks, CA. In this... ...Suite Exceptional attention to detail and strong analytical skills Excellent written and verbal communication...Work at officeRemote work
$68.64k - $82.37k
...Job Overview The Delegation Oversight Nurse Auditor is responsible for performing... ...regulations and standards. This position utilizes a rapid team approach for needed improvements... ...A minimum of 3 years of experience in managed care is required. Minimum of 2 years...Full timeFlexible hours$60k - $65k
...Description NKSFB, LLC is the largest business management firm in the country, with more than 650... ...Entertainment. We are seeking a Staff Auditor to be a key contributor in our Audit... ...and changes. What You Need To Succeed: Analytical skills, both qualitative and quantitative...Temporary workWork experience placementSummer workWork at officeFlexible hours$88.85k
...achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily... ...Generates approval, modification, and denial communications for inpatient admission... ...%) Applies clinical expertise and the nursing process to triage and prioritize...Full timeAll shiftsShift workNight shiftAfternoon shift$68.64k - $82.37k
...Job Overview The Delegation Oversight Nurse Auditor is responsible for performing delegation... ...regulations and standards. This position utilizes a rapid team approach for needed... ...A minimum of 3 years of experience in managed care is required. Minimum of 2 years Utilization...Local areaFlexible hours$110k - $150k
...communities. Under the supervision of the SVP, Chief Internal Auditor and the VP, IT Audit Manager, the AVP, IT Internal Audit Supervisor leads complex... ...in the department and within the organization. Strong analytical thinker and detail oriented with the ability to...Full timeWork experience placementWork at officeImmediate startFlexible hours- TikTok is seeking a Senior Internal Auditor (General Audit) in Los Angeles. You will drive end-to-end audit projects... ...process improvements, and report findings to senior management. This role emphasizes data analytics, cross-functional collaboration, and travel to North...
- Healthcare Executive Placements, Inc. (HCEPInc) is seeking an Interim Nurse Manager, Utilization Management for a W-2 contract position in Downey, CA. You will lead 24-hour departments, ensure high-quality, cost-effective patient care, and align services with regulatory...Contract workInterim role
$110k
Overview The Nurse Clinical Supervisor, UM Denial Compliance oversees the denial process within the utilization management (UM) department, ensuring that all denials are handled efficiently, accurately, and in full compliance with regulatory, accreditation, and health plan...Casual workRelocation package$88.85k
...safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves... ...determination status. Generates approval, modification and denial communications, to include member and provider...$88.85k
RN Job Utilization Management Nurse Specialist RN II Shift Full Time Pay Range $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)... ...determination status. Generates approval, modification and denial communications, to include member and provider notification...Full timeShift work$85.5k - $108.42k
...an active role in discussions with the Manager and Partner relative to business recommendations... ...wide learning and development programs. Utilize your entrepreneurial skills to network... ...project management, organizational and analytical skills, initiative, adaptability...Local areaWorldwide- ...understanding of audit issues. Ability to utilize firm technology to enhance client... ...Performs accounting research and tests analytical procedures on financial data. Identifies... ...status of work and issues with seniors, managers, or partners in a timely manner. Works with...InternshipWork at office
- L.A. Care Health Plan in Los Angeles, CA seeks an Utilization Management Nurse Specialist RN II to coordinate and approve referrals that meet criteria. You will monitor inpatient admissions, conduct telephonic or onsite reviews, and collaborate with on-site staff to discharge...
- American Traveler is hiring an RN Case Manager for an inpatient Care Management role requiring CA RN licensure and RN case management... ...and timeliness of interdisciplinary care plans and resource utilization Provides oversight and data collection for regulatory and accreditation...Local areaDay shift
$107k - $135k
...Position Type Regular The Senior Internal Auditor III plays a key role in strengthening... ...position serves as a trusted advisor to management by providing insight, guidance, and practical... ...or interest in leveraging data analytics, audit automation, and emerging audit technologies...Full timeWork at officeMonday to Thursday- L.A. Care Health Plan in Los Angeles, CA is seeking a Utilization Management (UM) Claims Review Nurse RN II to evaluate medical claims for medical necessity, documentation, and proper coding. This role supports payment integrity through pre-payment and retrospective reviews...
$64.58k - $80.75k
...despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day. Job Overview The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization requests from all lines of business using respective national/...Hourly payFull timeFlexible hours$113k - $135k
...We are seeking a Senior Technology Auditor to support the expansion of the... ...environment, including identity and access management, network configurations, logging... ...to seek innovative ways to utilize AI tools and advanced analytics to facilitate efficiencies and enhance...Local areaImmediate startWorldwide$70k - $110k
...Participates in engagement planning Performs analytical reviews Documents internal controls and... ...engagements Client Relationship Management Clearly communicates recommendations verbally... ...knowledge of the auditing guidance utilized by the firm Strong attention to detail...Full timeFlexible hours
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