Utilization Review Nurse

Job Title Nurse Chart Reviewer (Hybrid) Location West Hills/Canoga Park, CA 91305 Job Type Contract to Hire Pay & Benefits Pay range: $35.00 - $50.00/hr. Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave) Responsibilities Audit denied provider and member claims for accuracy and compliance Review and process claims in accordance with UM guidelines and regulatory standards Analyze benefit structures and system configurations (EZCap or similar) Collaborate with cross-functional teams to resolve claim issues and process gaps Document findings, prepare reports, and present trends to leadership Support automated adjudication systems and identify strategies to reduce errors Ensure HIPAA and PHI compliance throughout all claim review activities Participate in special projects related to claim denials and appeals Required Qualifications Active LVN or RN license (California) 2+ years of experience in Utilization Management (UM) Hands-on experience with HMO/Medicare claims, audits, and denials Familiarity with claims processing systems (EZCap or similar) Strong analytical, documentation, and communication skills Ability to work independently and prioritize tasks Proficiency in MS Office Suite (Excel, Access, PowerPoint, Word) Preferred Skills CPT, HCPCS, ICD-10 coding knowledge Advanced Excel skills Experience with regulatory agencies and compliance audits Application Deadline Position anticipated to close on Jun 12, 2026. Equal Opportunity Employment The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. #J-18808-Ljbffr TEKsystems