Top 9 Utilization review nurse Jobs in Ventura, Ca

Registered Nurse Clinicial Claims Review
Wollborg Michelson Recruiting —California
- $67.00 - $68.73 an hour
- Full-time
- Remote
- LVN
- RN License
- 5 years
- Health insurance
- Dental insurance
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6d
Practice Advancement Specialist RN
Livingston Memorial VNA —Ventura, CA
- $87,360 - $95,680 a year
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid training
- Mileage reimbursement
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12d
UM Genetic Counselor Medical Reviewer
Wollborg Michelson Recruiting —California
- $62.00 - $64.70 an hour
- Full-time
- LVN
- Windows
- Master's degree
- Health insurance
- Dental insurance
Quick Apply
6d

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Registered Nurse Clinicial Claims Review
Wollborg Michelson Recruiting —California
Active RN or LVN license. Reviews clinical claims through post-service evaluation, assesses medical necessity and policy compliance, and determines whether…
$67.00 - $68.73 an hour
Quick Apply
6d
Occupational Therapist
Oxnard Manor Healthcare Center —Oxnard, CA
Aids in the restoration and enhancement of independent function in those individuals whose living status has been compromised by illness and/or injury:…
$55.00 - $63.76 an hour
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Utilization Review Specialist - Autism
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Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
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International SOS —Columbus, OH
Valid Ohio State NP license. This role combines advanced clinical practice with operational oversight, including patient assessment, diagnosis, treatment, and…
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utilization review nurse jobs near ventura, ca

Registered Nurse Clinicial Claims Review

Wollborg Michelson Recruiting -
California

Quick Apply

Job Details

Full-time | Contract
$67.00 - $68.73 an hour
6 days ago

Benefits

Health insurance
Dental insurance
Vision insurance

Qualifications

Medical claims
Utilization review
LVN
RN License
Attention to detail
Documentation review
Nursing

Full Job Description

Registered Nurse – Clinical Claims Review

Fully Remote

Must Reside in CA

Registered CA LIC

Job Summary

Reviews clinical claims through post-service evaluation, assesses medical necessity and policy compliance, and determines whether retrospective claims should be paid according to plan benefits and policies. Collaborates with claims teams, physicians, pharmacists, and prior authorization staff.

Responsibilities

Review clinical claims and retrospective services.
Evaluate medical necessity and compliance with benefits and policies.
Determine appropriate claim payment outcomes.
Collaborate with claims, physician, pharmacy, and prior authorization teams.

Requirements

Active RN or LVN license.
Minimum of five years of experience demonstrating strong clinical judgment.
Experience with post-service review, prior authorization, or concurrent review.
Highly detail-oriented.

Summary Qualification

Licensed nursing professional with clinical claims review experience.
Strong knowledge of medical necessity and benefits or policy requirements.
Prior post-service review experience preferred.

Skill

Clinical judgment.
Claims review.
Medical necessity evaluation.
Strong attention to detail.
Computer skills and familiarity with clinical or claims systems.

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one’s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one’s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.

Pay: $67.00 - $68.73 per hour

Benefits:

Dental insurance
Health insurance
Vision insurance

Work Location: Remote

Quick Apply

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utilization review nurse jobs in ventura, ca

Registered Nurse Clinicial Claims Review

Practice Advancement Specialist RN

UM Genetic Counselor Medical Reviewer

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