Top 283 Denials management Jobs in Arcadia, Ca

Utilization Management Outpatient Authorization Nurse
Champion Health Plan is a Medicare Advantage Prescription Drug HMO C-SNP serving Medicare beneficiaries with End-Stage Renal Disease. —Long Beach, CA
- From $67,000 a year
- Full-time
- Nursing
- LVN
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
Office Administrator - Medical Billing Company
Certified Healthcare Billing —Sunland, CA
- $21 - $30 an hour
- Full-time
- HIPAA
- Office
- Administrative experience
- Health insurance
- 401(k)
Quick Apply
4d
Hospital AR Account Representative
Ethos Management (Servicing AHMC Hospitals) —Alhambra, CA
- $21 - $23 an hour
- Full-time
- Microsoft Word
- Microsoft Excel
- Management
- Health insurance
- Dental insurance
Quick Apply
Director of Case Management - $15K SignOn - Kindred Hospital Los Angeles
Kindred Hospitals —Los Angeles, CA
- $124,000 - $181,000 a year
- Full-time
- Background check
- Nursing
- Microsoft Excel
- Health savings account
- Health insurance
Quick Apply
13d
Managed Care Collector
Ethos Management (Servicing AHMC Hospitals) —Alhambra, CA
- $24 - $27 an hour
- Full-time
- Microsoft Excel
- HIPAA
- In-person
- Health insurance
- Dental insurance
Quick Apply
Billing Support Specialist (Remote)
Rula —Los Angeles, CA
- $51,000 - $57,000 a year
- Full-time
- Remote
- Mid-level
- 1 year
- Leadership
- Paid parental leave
- Health savings account
3d
Health Care Professional – Utilization Review / First-Level Reviewer
Encompass Health Solutions, Inc. —Los Angeles, CA
- $42 - $45 an hour
- Overtime
- Remote
- LVN
- RN License
- Mid-level
Quick Apply
4d
Revenue Cycle Specialist I (Cash Management)
Cedars-Sinai —Los Angeles, CA
- $25.00 - $32.61 an hour
- 8 hour shift
- High school diploma or GED
- Fair chance
- Associate's degree
- Health insurance
- Paid time off
Revenue Reimbursement Coordinator (Glendale) Full-time, Day
Adventist Health —Glendale, CA
- $39.16 - $53.71 an hour
- Full-time
- Medical office experience
- Mid-level
- Office
Housing Coordinator - UHA Services Coordinator
HOM, INC. —Burbank, CA
- $38.95 - $41.17 an hour
- Full-time
- Bilingual
- Background check
- Microsoft Excel
Quick Apply
4d
Mental Health and Disabilities Coordinator
Plaza De La Raza Child Development Services Inc —City of Industry, CA
- $34.85 - $38.47 an hour
- Full-time
- Bilingual
- Experience working with individuals with disabilities
- Mid-level
- Paid jury duty
- Paid holidays
Long-Term Care Pharmacy Biller
IntegroCura Inc —Covina, CA
- $20 - $30 an hour
- Full-time
- HIPAA
- Research
- Entry level
Quick Apply
Collector, Management Services Organization/Centralized Billing Office - CBO - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
USC —Pasadena, CA
- $26.00 - $41.28 an hour
- 8 hour shift
- Microsoft Excel
- Customer service
- Research
Case Manager - Care Coordination - Full Time 8 hours Day (Union, Non-Exempt)
Keck Medical Center of USC —Arcadia, CA
- $46.00 - $76.07 an hour
- 8 hour shift
- Background check
- Nursing
- RN License
Case Manager - Care Coordinator - Full Time 8 hours Days (Union, Non-Exempt)
Keck Medical Center of USC —Arcadia, CA
- $46.00 - $76.07 an hour
- 8 hour shift
- Background check
- Nursing
- RN License
Chart Auditor - Glendale
Adventist Health —Glendale, CA
- $62.83 - $86.18 an hour
- Full-time
- Nursing
- RN License
- Mid-level
Denial Specialist - Business Office - Full Time - Days - 8hr Glendora, California
Emanate Health —Glendora, CA
- $25.53 - $38.29 an hour
- 8 hour shift
- 5 years
- Office
- High school diploma or GED
Case Manager - Care Coordination - Full Time 8 hours Days (Union, Non-Exempt)
Keck Medical Center of USC —Arcadia, CA
- $46.00 - $76.07 an hour
- 8 hour shift
- Background check
- Nursing
- RN License
Non-Government Collector - Patient Accounting - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
USC —Los Angeles, CA
- $26.00 - $41.28 an hour
- 8 hour shift
- Mid-level
- High school diploma or GED
- Medical terminology
2d
Director of Rehabilitation
Ensign Affiliate —San Gabriel, CA
- $115,000 - $135,000 a year
- Full-time
- Physical & Rehabilitation Medicine
- 3 years
- Administrative experience
- Continuing education credits
- Health insurance

I want to receive the latest job alert for denials management in arcadia, ca

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

denials management jobs near arcadia, ca

Case Coordinator jobs in Arcadia, CA

Collector jobs in Alhambra, CA

Medical Biller jobs in Sunland, CA

Revenue Cycle Specialist jobs in Los Angeles, CA

Director Of Case Management jobs in Los Angeles, CA

Collector jobs in Los Angeles, CA

Utility Manager jobs in Long Beach, CA

Utilization Review Nurse jobs in Los Angeles, CA

Billing Specialist jobs in Los Angeles, CA

Case Coordinator jobs in Colorado

Remote Operations Coordinator jobs in New York, NY

Part Time Case Manager jobs in Houston, TX

Case Coordinator jobs in Boston, MA

Case Manager Entry Level jobs in Houston, TX

Case Coordinator jobs in Dekalb, IL

Case Coordinator jobs in San Francisco, CA

Program Coordinator jobs in Dallas, TX

Health Coordinator jobs in Trinity, FL

Health Coordinator jobs in College Station, TX

Clinical Research Coordinator jobs in San Jose, CA

Utilization Management Outpatient Authorization Nurse

Champion Health Plan is a Medicare Advantage Prescription Drug HMO C-SNP serving Medicare beneficiaries with End-Stage Renal Disease.
Long Beach, CA

Quick Apply

Job Details

Full-time
From $67,000 a year

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance
Life insurance

Qualifications

Nursing
LVN
Outpatient experience
Bachelor's degree
Utilization management
Attention to detail
Organizational skills
Nursing
Time management

Full Job Description

Job Overview

The Utilization Management Pre-Authorization Nurse is responsible for managing outpatient utilization by conducting thorough reviews of clinical documentation and applying clinical knowledge in accordance with Milliman Care Guidelines (MCG), InterQual Criteria, Medicare Advantage (MCAL), and CMS regulations. This role ensures that all authorizations, deferrals, and denials are processed efficiently, accurately, and in compliance with company policies and regulatory standards, including CMS, Department of Health Care Services (DHCS), and Department of Managed Health Care (DMHC) requirements. The nurse also issues timely and accurate denial, deferral, or authorization letters, manages clinical review processes, and supports compliance with health plan guidelines.

KEY RESPONSIBILITIES

Manage all authorizations, deferrals, and denials by conducting comprehensive reviews of clinical documentation, applying clinical criteria and guidelines such as MCG, InterQual, UpToDate, and CMS.
Review authorizations, deferrals, and denials for medical necessity, ensuring adherence to regulatory and health plan criteria, policies, and Evidence of Coverage (EOC).
Apply clinical knowledge when processing deferrals and denials, supported by regulatory guidelines from CMS, DMHC, DHCS, and health plan policies.
Ensure timely and accurate processing of all authorizations, deferrals, and denials in compliance with company and departmental policies and procedures.
Process 30-40 deferral or denial letters daily with accuracy, maintaining high standards of quality.
Review and process denials, modifications, and carve-outs according to established procedures and clinical criteria.
Use clinical expertise to apply MCG, InterQual, and other relevant clinical guidelines to ensure that medical decisions align with best practices and regulations.
Review all applicable benefit policies and Evidence of Coverage (EOC) to ensure accurate decisions regarding coverage and medical necessity.
Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance departments to ensure clear communication and appropriate utilization of healthcare services.
Coordinate with the Appeals team to support the completion of appeal and denial letters as needed.
Comply with internal policies and procedures to ensure timely and accurate processing of all deferrals, denials, and modification requests.
Stay up-to-date with changes in regulatory requirements (CMS, DMHC, DHCS) and integrate new policies into daily processes.
Perform additional duties, projects, and actions as assigned to support department goals and operational needs.

QUALIFICATIONSEducation

Licensed Vocational Nurse (LVN) with an active, unrestricted license in the state of practice.
Bachelor’s degree in Nursing (preferred, but not required).

Experience

Minimum of 3 years of clinical nursing experience, with a focus on Utilization Management or managed care preferred.
Familiarity with Milliman Care Guidelines (MCG), InterQual, Medicare, Medicaid, and CMS regulations.
Utilization management experience with a Health Plan or Management Services Organization (MSO).

Knowledge, Skills, and Abilities

Strong knowledge of MCG, InterQual Criteria, Medicare (MCAL), and CMS guidelines.
Proficient in applying clinical knowledge to support medical necessity decisions based on health plan policies, benefit guidelines, and regulatory criteria.
Excellent organizational skills and the ability to process a high volume of deferral and denial letters with accuracy and attention to detail.
Strong communication skills, both verbal and written, especially in creating clear and compliant deferral and denial letters.
Ability to collaborate with cross-functional teams, including providers and internal UM teams.
Exceptional follow-through abilities to track all outstanding tasks and coordinate with assigned owners to ensure tasks are completed in a timely manner.
Strong organizational skills, attention to detail, and sound decision-making skills required.
Ability to manage multiple projects of varying complexity, priority levels, and deadlines.
Proficient knowledge of Health Plan, DMHC, DHCS, CMS, HIPAA, and NCQA requirements.

PROFESSIONAL COMPETENCIES

Strong problem-solving skills with the ability to analyze and apply clinical guidelines and policies.
Excellent organizational and time management skills to meet deadlines while maintaining accuracy.
Ability to thrive in a fast-paced, results-driven environment.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS

The majority of work responsibilities are performed in an office setting, working on a computer.
Regularly required to talk, hear, stand, walk, sit, and use hands to handle or feel objects and controls.

Job Type: Full-time

Pay: From $67,000.00 per year

Benefits:

401(k)
Dental insurance
Health insurance
Life insurance
Vision insurance

Experience:

Outpatient: 3 years (Required)
Utilization management: 3 years (Preferred)

License/Certification:

LVN (Preferred)

Location:

Long Beach, CA 90815 (Required)

Work Location: In person

Quick Apply

Refine Your Search

denials management jobs in arcadia, ca

Utilization Management Outpatient Authorization Nurse

Office Administrator - Medical Billing Company

Hospital AR Account Representative

Director of Case Management - $15K SignOn - Kindred Hospital Los Angeles

Managed Care Collector

Billing Support Specialist (Remote)

Health Care Professional – Utilization Review / First-Level Reviewer

Revenue Cycle Specialist I (Cash Management)

Revenue Reimbursement Coordinator (Glendale) Full-time, Day

Housing Coordinator - UHA Services Coordinator

Mental Health and Disabilities Coordinator

Long-Term Care Pharmacy Biller

Collector, Management Services Organization/Centralized Billing Office - CBO - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Case Manager - Care Coordination - Full Time 8 hours Day (Union, Non-Exempt)

Case Manager - Care Coordinator - Full Time 8 hours Days (Union, Non-Exempt)

Chart Auditor - Glendale

Denial Specialist - Business Office - Full Time - Days - 8hr Glendora, California

Case Manager - Care Coordination - Full Time 8 hours Days (Union, Non-Exempt)

Non-Government Collector - Patient Accounting - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Director of Rehabilitation

I want to receive the latest job alert for denials management in arcadia, ca

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected