Hybrid Utilization Review Nurse | Prior Authorization
$30 - $34 per hourAstrana Health
A health services company is seeking a Utilization Management Review Nurse in Monterey Park, CA. This hybrid role includes conducting reviews for inpatient admissions and outpatient procedures, ensuring compliance with regulations, and working collaboratively with the team. Candidates must have an active LVN license in California, experience in health plans, and strong interpersonal skills. Compensation ranges from $30.00 to $34.00 per hour with weekend and holiday coverage as needed. #J-18808-Ljbffr Astrana Health
$34 - $47 per hour
Astrana Health, Inc. seeks a CA-licensed UM Review Nurse to work remotely, approving or denying outpatient services based on medical... ...overtime required. Responsibilities include conducting prior authorization reviews and maintaining regulatory knowledge. Competitive compensation...SuggestedRemote jobHourly payFull timeFlexible hours$35 - $50 per hour
...Job Title : Nurse Chart Reviewer Location : West Hills/Canoga Park 91305 (This role is HYBRID not remote) Overview: The Retro Claims Reviewer is responsible for... ...Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding...SuggestedContract workTemporary work$34 - $47 per hour
Astrana Health is seeking a CA-licensed Utilization Review Nurse for remote work. This role involves using clinical judgment to approve or deny outpatient medical services based on Medical Necessity Criteria. Candidates must have at least one year of outpatient UM experience...SuggestedRemote jobHourly payShift work$31.93 per hour
...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... ...managed care experience in Utilization Management/prior authorization required. A minimum...SuggestedHourly payFlexible hours- ...organization in Los Angeles, CA, seeks a Denials Nurse Supervisor (RN or LVN) to lead a team in Prior Authorization operations. The role emphasizes collaboration, clinical... ...experience and strong communication skills. A hybrid work model and competitive benefits are offered....Suggested
$88.85k
...Utilization Management Claims Review Nurse RN II Job Category: Clinical Department: Utilization Management... ...team in evaluating flagged claims prior to adjudication to ensure services... ...is accurate and aligned with authorization when applicable, and unnecessary denials...Full time$74.16 - $107.75 per hour
Description The Utilization Review Nurse is part of the Utilization Management Department at the Resnick... ...party payors in order to obtain authorization, supporting the revenue cycle. Acts as... ...BLS from the ARC or AHA, required. Prior case management experience, highly desired...Work at office$74.29k - $111.43k
...better care experience for all. Job Summary The Concurrent Utilization Review (UR) Nurse is responsible for conducting real‑time clinical reviews... ...recommendations and resolve discrepancies in care. Authorization & Payer Communication Process authorization requests for...Work at office$74.16 - $107.75 per hour
Description The Utilization Management (UM) Nurse supports appropriate level‑of‑care determination,... ...for coverage purposes utilization review/payor authorization and patient placement‑ensuring continuity... ...from the ARC or AHA, required. Prior case management experience,...Work at office$30 - $34 per hour
...Health Services (HS - UM) Job Title Utilization Management Review Nurse About the Role Astrana Health is... ...Health Services Department. This hybrid position requires availability... ...needed. What You’ll Do Complete prior authorization/retrospective reviews of elective...Hourly payWork at officeMonday to FridayShift work$34 - $47 per hour
UM Review Nurse - LVN Department: HS - UM Employment Type: Full Time... ...looking for a CA-licensed Utilization Review Nurse to assist our... ...What You'll Do Complete prior authorization/retrospective review of elective... ...may be expected to work hybrid. Typical business hours are...Hourly payFull timeLive inWork at officeRemote workMonday to FridayShift work$74.16 - $107.75 per hour
UCLA Outpatient Clinics is seeking a Utilization Review Nurse for its Utilization Management Department at the Resnick Neuropsychiatric Hospital... ...performing clinical reviews with third party payors for authorization and managing appeals. Candidates will collaborate with...Hourly pay$74.16 - $107.75 per hour
Veterans in Healthcare is looking for a Utilization Review Nurse to work in Los Angeles, CA. This role is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital and supports various treatment programs. The ideal candidate will perform clinical...Hourly payMonday to Friday$140k - $150k
...Nurse Practitioner/Physician Assistant - Hybrid (San Bernardino) Department: Quality - Risk Adjustment Ops Employment Type: Full Time Location:... ...factors, and support long-term wellness planning. You will review and update medical histories, evaluate health risks,...Full timeLocal area10 hours per weekShift work- A leading healthcare provider in Montebello, CA is looking for a skilled Registered Nurse, In-Patient Case Manager. This hybrid role involves coordinating care for patients in hospital settings and managing complex cases, including those with chronic conditions. Applicants...
- ...POSITION SUMMARY The RN Utilization Management (RN UM)... ...stays, and discharge review that determine medical... ...with insurance for authorization as needed. The RN UM ensures... ...and attachments prior to submitting them to... ...Associates Degree in Nursing required. BSN preferred...Full time
$74.16 - $107.75 per hour
The University of California - Los Angeles Health is seeking a Utilization Review Nurse to support its Utilization Management Department. This role involves clinical reviews with payors for authorization, acting as a liaison with treatment teams, and ensuring documentation...Hourly pay$31 - $45 per hour
...standard hours M-F and offers training for individuals without prior case management experience. The ideal candidate will coordinate... ....00 per hour, depending on qualification and experience, with a hybrid work structure allowing for both at-office and remote work. #J-1...Hourly payFull timeWork at officeRemote work- ...unpaid lunch Onsite or Hybrid: Onsite POSITION... ...of the Deputy Chief Nursing Officer, the... ...frames with efficient utilization of resources. In addition... ...to be rescheduled, by reviewing the medical record and... .... Obtain prior authorizations for medications...Full timeWork at officeMonday to FridayFlexible hours
- ...an Appeals and Grievances RN Senior responsible for clinically reviewing member appeals and grievances related to service or claims denials... ...using established guidelines and ensure compliance. This hybrid role allows virtual work full-time with on-site requirements based...Full time
- ...in Los Angeles, CA. This role involves reviewing member appeals and grievances, ensuring... ...candidate holds a Bachelor of Science in Nursing and a current California RN License with... ...relevant experience. The position allows for hybrid virtual work, balancing remote...Work at officeRemote work
- ...ranked #2 among large organizations for hybrid work. The organization's Healthtech excellence... ...monitoring tasks are implemented and utilized. Conducts and leads project meetings... ...and processes as well as clinical nursing policies and procedures. Solid grasp with...Live inRemote workRelocationShift work
- ...responsible for managing appeals and grievances. This role entails reviewing complex clinical cases, ensuring compliance with healthcare... ...include paid time off, tuition reimbursement, and medical plans. A hybrid work model is in place. #J-18808-Ljbffr L.A. Care Health Plan
$135k - $145k
...regulatory requirements. In this hybrid role, you’ll split your time... .... Lead clinical eligibility reviews: Facilitate clinical eligibility... ..., helping present and review nursing recommendations for potential... ...necessary proof of vaccination prior to employment. Beware of Scams...Temporary workPart timeWork at officeLocal areaRemote workMonday to FridayFlexible hours- A skilled nursing facility in Los Angeles is urgently hiring for a hybrid Licensed Vocational Nurse (LVN) position. The role involves providing daily nursing care, monitoring vital signs, and ensuring compliance with health standards. A valid LVN license, CPR/BLS card,...Immediate startDay shiftAfternoon shift
- ...Unlimited Incentives PMHNP: $174,000+ ~ Hybrid Schedule affording a Flexible Mix of In-... ...a Variety of Mental Health Areas Utilize EHR & Technology Platforms within the role... ...License with a Psychiatric Mental Health Nurse Practitioner Certification (PMHNP-BC) in...Full timeWork at officeLocal areaRelocationMonday to FridayFlexible hours
$110k - $120k
...that improve health outcomes. Ideal candidates possess a valid RN license, experience in care management, and strong communication skills. This position offers a hybrid working model with a salary range of $110,000 - $120,000 annually. #J-18808-Ljbffr Blue Zones Health$37 - $50 per hour
...Clinical Denials Nurse (RN or LVN) Northridge, CA CareNational is looking for... ...experience) Work Setting: ~ Hybrid (both in-office and work from home)... ...healthcare field. Minimum of 3+ year of prior authorization/ denials experience Minimum of 1+ year...Hourly payImmediate startWork from home$55 - $65 per hour
American Homecare is seeking a Registered Nurse (RN) in Los Angeles, CA to deliver nursing care in home environments. The role requires... ...in clinical or home health settings. The position offers a hybrid schedule with competitive hourly pay ranging from $55 to $65, providing...Hourly pay$100k - $105k
Denials Nurse Supervisor (RN or LVN) Northridge, CA | Hybrid LVN Pay: $100,000-$105,000 a year RN... ...LVN) to help lead our Prior Authorization, Denials, and Appeals... ...and excellence in every review. Oversee daily... ...experience (managed care, utilization management, or prior authorization...Casual work
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