Top 2907 Nurse Jobs in Long Beach, 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
Registered Nurse (RN)
E&V Adult Day Health Care —Compton, CA
- $35 - $45 an hour
- Part-time
- Background check
- Management
- Current TB test
- Flexible schedule
Quick Apply
7d
NOW HIRING: Interventional Radiology RN – Long Beach, CA
VI Staffing Inc. —Long Beach, CA
- $3,000 - $3,400 a week
- Temporary
- CPR Certification
- RN License
- Hospital
- Relocation assistance
Quick Apply
Acute Dialysis RN
U.S. Renal Care —Long Beach, CA
- $47.21 - $70.82 an hour
- Full-time
- Acute care
- CPR Certification
- Nursing
- Health insurance
- Dental insurance
Registered Nurse
U.S. Renal Care —Long Beach, CA
- Full-time
- Patient monitoring
- RN License
- Mid-level
- Health insurance
- Dental insurance
4d
RN | School Nurse | SW Los Angeles | Full Time - Per Diem | 34811
RO Health —Long Beach, CA
- $38 - $42 an hour
- Part-time
- CPR Certification
- Nursing
- RN License
- Paid training
- Health insurance
Quick Apply
7d
Registered Nurse- GI
US Veterans Health Administration —Long Beach, CA
- $111,502 - $190,737 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
4d
RN New grads OK
Long Beach Healthcare Center —Long Beach, CA
- $45 - $55 an hour
- Part-time
- CPR Certification
- Nursing
- Skilled nursing facility
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse -Acute Care- DOU
US Veterans Health Administration —Long Beach, CA
- $116,566 - $210,371 a year
- Online Application
- Acute care
- Background check
- Nursing
- Paid holidays
- Dental insurance
2d
Registered Nurse RN
Harborview Center —Long Beach, CA
- $45.00 - $47.60 an hour
- Part-time
- Nursing
- RN License
- Mid-level
- Wellness program
- Health savings account
Quick Apply
RN Call Center Nurse Per Diem - Remote
Optum —Torrance, CA
- $29 - $52 an hour
- Part-time
- Remote
- Nursing
- RN License
- PALS Certification
Quick Apply
4d
IV Infusion Nurse
Kalologie Southern CA —Long Beach, CA
- $40 - $45 an hour
- Part-time
- RN License
- Clinic experience
- Mid-level
Quick Apply
RN GI Services
St Mary Medical Center —Long Beach, CA
- $58.70 - $73.30 an hour
- Full-time
- Acute care
- RN License
- Hospital
Care Management - Nurse, Senior (DSNP)
Blue Shield of California —Long Beach, CA
- $89,100 - $133,650 a year
- Full-time
- Hybrid work
- Background check
- Nursing
- RN License
- Work from home
RN, Children's Village - Endocrinology/Diabetes
Miller Children's Hospital —Long Beach, CA
- $58.48 - $79.57 an hour
- 8 hour shift
- Nursing
- Current TB test
- RN License
- Health insurance
Staff RN
AHMC Healthcare —Anaheim, CA
- $46.02 - $53.01 an hour
- Full-time
- Nursing
- RN License
- PALS Certification
Registered Nurse (RN) - OR
Long Beach Memorial Medical Center —Long Beach, CA
- $50.74 - $77.79 an hour
- Full-time
- Nursing
- RN License
- BLS Certification
- Health insurance
11d
Registered Nurse
CREATING A LEGACY INC —Long Beach, CA
- $65 - $78 an hour
- Part-time
- Nursing
- Patient monitoring
- RN License
- Health insurance
- Paid time off
Quick Apply
3d
Nurse Navigator - DHI Administration - FT Days
University of California, Irvine —Orange, CA
- $68.86 - $100.34 an hour
- Full-time
- Background check
- Spanish
- Nursing
- Health insurance
- Retirement plan
Assistant Clinical Nurse Manager
WelbeHealth —Long Beach, CA
- $129,521.60 - $161,865.60 a year
- Overtime
- Nursing
- RN License
- Clinic experience
- Health insurance
- Dental insurance
Quick Apply

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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

nurse jobs in long beach, ca

Utilization Management Outpatient Authorization Nurse

Registered Nurse (RN)

NOW HIRING: Interventional Radiology RN – Long Beach, CA

Acute Dialysis RN

Registered Nurse

RN | School Nurse | SW Los Angeles | Full Time - Per Diem | 34811

Registered Nurse- GI

RN New grads OK

Registered Nurse -Acute Care- DOU

Registered Nurse RN

RN Call Center Nurse Per Diem - Remote

IV Infusion Nurse

RN GI Services

Care Management - Nurse, Senior (DSNP)

RN, Children's Village - Endocrinology/Diabetes

Staff RN

Registered Nurse (RN) - OR

Registered Nurse

Nurse Navigator - DHI Administration - FT Days

Assistant Clinical Nurse Manager

I want to receive the latest job alert for nurse in long beach, ca

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