Top 343 Denials management Jobs in Los Angeles, 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
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
Director, Revenue Operations - Health Insurance Contracts
Easter Seals Southern California, Inc. —Gardena, CA
- From $116,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
6d
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
Medical Record Document Chaser (Los Angeles)
St Joseph Medical Equipment Corp —Encino, CA
- $24 - $27 an hour
- Full-time
- Background check
- Microsoft Excel
- Customer service
- Health insurance
- Paid time off
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
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
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
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
Patient Biller 3
UCLA Health —Los Angeles, CA
- $30.79 - $40.60 an hour
- Microsoft Excel
- Medical office experience
- Mid-level
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
Medicaid Revenue Cycle Operations Manager - Remote
AngelSense —Santa Monica, CA
- $100,000 - $120,000 a year
- Full-time
- Remote
- Applied behavior analysis
- Experience working with individuals with disabilities
- 5 years
- Health insurance
- Dental insurance
Quick Apply
11d
Epic Denials Management Operator
Deloitte —Inglewood, CA
- $70,000 - $90,000 a year
- Full-time
- Microsoft Excel
- Mid-level
- Bachelor's degree
Clinical Documentation Integrity Specialist
UCLA Health —Los Angeles, CA
- $100,161.36 - $218,718.00 a year
- RN License
- Computer literacy
- Mid-level
Claims Manager
AIDS Healthcare Foundation —Los Angeles, CA
- $90,000 - $100,000 a year
- Inventory management
- Mid-level
- Health insurance
Quick Apply
Chart Auditor - Glendale
Adventist Health —Glendale, CA
- $62.83 - $86.18 an hour
- Full-time
- Nursing
- RN License
- Mid-level
Collector- CBO Full Time Day Shift
Avanti Hospitals —Cerritos, CA
- $24.93 - $36.66 an hour
- Full-time
- HIPAA
- Mid-level
- Organizational skills
Quick Apply
Open Until Filled
Westside Regional Center —Culver City, CA
- $22.50 - $33.00 an hour
- Hybrid work
- Experience working with individuals with developmental disabilities
- Spanish
- Microsoft Outlook
Epic Denials Management Coordinator
Deloitte —Inglewood, CA
- $50,000 - $60,000 a year
- Full-time
- Microsoft Excel
- Mid-level
- Bachelor's degree
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

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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

denials management jobs in los angeles, ca

Utilization Management Outpatient Authorization Nurse

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

Director, Revenue Operations - Health Insurance Contracts

Managed Care Collector

Medical Record Document Chaser (Los Angeles)

Billing Support Specialist (Remote)

Revenue Reimbursement Coordinator (Glendale) Full-time, Day

Revenue Cycle Specialist I (Cash Management)

Health Care Professional – Utilization Review / First-Level Reviewer

Patient Biller 3

Housing Coordinator - UHA Services Coordinator

Medicaid Revenue Cycle Operations Manager - Remote

Epic Denials Management Operator

Clinical Documentation Integrity Specialist

Claims Manager

Chart Auditor - Glendale

Collector- CBO Full Time Day Shift

Open Until Filled

Epic Denials Management Coordinator

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

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