Top 3680 Office nurse Jobs in Torrance, 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 Pre-Op/PACU
K and B Surgical Center —Beverly Hills, CA
- From $60 an hour
- Extended hours
- Background check
- Surgery
- Patient monitoring
Quick Apply
Dermatology Medical Assistant
Beach Cities Dermatology —Redondo Beach, CA
- $18.50 - $23.00 an hour
- Urgently hiring
- Private practice
- Surgery
- Medical office experience
- Travel reimbursement
- Health insurance
Quick Apply
Registered Nurse Case Manager
Medcadre Inc —Torrance, CA
- $53 - $70 an hour
- 8 hour shift
- RN License
- BLS Certification
- Mid-level
Quick Apply
5d
RN Patient Care Manager
VITAS Healthcare —Torrance, CA
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Medical Assistant Apprentice
Providence —Torrance, CA
- $25.00 - $31.19 an hour
- Full-time
- Fair chance
- Entry level
- Under 1 year
- Paid parental leave
- Paid holidays
4d
RN Call Center Nurse Per Diem - Remote
Optum —Torrance, CA
- $29 - $52 an hour
- Part-time
- Remote
- Nursing
- RN License
- PALS Certification
Quick Apply
1d
Medical Assistant
Providence —Torrance, CA
- $25.00 - $37.11 an hour
- Full-time
- Vital signs
- Military
- BLS Certification
- Paid parental leave
- Paid holidays
4d
RN - IV Wellness Clinic Per Diem
Hydration Room —Torrance, CA
- $50 - $60 an hour
- Part-time
- Nursing
- Management
- RN License
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse
Del Amo Hospital —Torrance, CA
- $43.00 - $61.14 an hour
- Part-time
- Acute care
- RN License
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
RN OR
Amergis Healthcare Staffing —Torrance, CA
- $3,199 a week
- Surgery
- RN License
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
RN – Oncology, Torrance
UCLA Health —Torrance, CA
- $70.59 - $106.80 an hour
- Nursing
- RN License
- BLS Certification
7d
RN Call Center Nurse - CA Remote
Optum —Torrance, CA
- $28.94 - $51.63 an hour
- Full-time
- Remote
- Nursing
- RN License
- PALS Certification
Quick Apply
23h
Medical Assistant- Torrance Skypark Primary & Specialty Care
UCLA Health —Torrance, CA
- $31.24 - $41.22 an hour
- Overtime
- Vital signs
- OSHA
- HIPAA
7d
Back-end Medical Office Staff
NakedMD —Manhattan Beach, CA
- Full-time
- LVN
- Organizational skills
- CNA
Quick Apply
1d
Palliative Admissions RN
Providence at Home with Compassus —Torrance, CA
- $53.25 - $82.68 an hour
- 8 hour shift
- Nursing
- RN License
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
Front office Medical Receptionist for Pregnancy Practice
Coastal Perinatal Center, Inc —Torrance, CA
- $18 - $22 an hour
- Full-time
- In-person
- Entry level
- Health insurance
- Dental insurance
Quick Apply
Hospice Registered Nurse
Agape Hospice and Palliative Care —Torrance, CA
- $65 - $70 an hour
- Email
- Skilled nursing facility
- RN License
- Mid-level
- Health insurance
- Dental insurance
Medical Assistant (Full Time)
Schweiger —Torrance, CA
- $21 - $26 an hour
- Weekends as needed
- Microsoft Excel
- Microsoft Outlook
- Customer service
- Health savings account
- Disability insurance
Quick Apply
Medical Office Assistant
PSI Surgical Practice —Torrance, CA
- Part-time
- Spanish
- English
- Patient care
- Free parking
- On-the-job training
Quick Apply

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office nurse jobs near torrance, 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

office nurse jobs in torrance, ca

Utilization Management Outpatient Authorization Nurse

Registered Nurse Pre-Op/PACU

Dermatology Medical Assistant

Registered Nurse Case Manager

RN Patient Care Manager

Medical Assistant Apprentice

RN Call Center Nurse Per Diem - Remote

Medical Assistant

RN - IV Wellness Clinic Per Diem

Registered Nurse

RN OR

RN – Oncology, Torrance

RN Call Center Nurse - CA Remote

Medical Assistant- Torrance Skypark Primary & Specialty Care

Back-end Medical Office Staff

Palliative Admissions RN

Front office Medical Receptionist for Pregnancy Practice

Hospice Registered Nurse

Medical Assistant (Full Time)

Medical Office Assistant

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