L.A. Care Health Plan - Nursing

Lead RN for Appeals & Grievances in Los Angeles. Leverage 8+ years of clinical managed care experience to mentor a team and resolve complex cases. Ensure regulatory compliance and improve audit outcomes for Medicare/Medicaid members. Enjoy benefits like PTO, tuition reimbursement, and wellness pr...

Seeking a detail-oriented **Delegation Oversight Clinical Auditor RN II** in **Los Angeles, CA**. Ensure delegate compliance with **Utilization Management (UM)** regulations and **Medi-Cal** requirements. Requires an **Associate's Degree in Nursing**, an active **California RN license**, and 7+ y...

Seeking a strategic **Manager, Utilization Management Claims Review** in **Los Angeles, CA**. This role leads a clinical team, driving **payment integrity** and ensuring regulatory compliance for **Medi-Cal** and **Medicare**. Requires an **RN with a California license** and 4+ years of managemen...

Seeking a Clinical Policy Clinical Coder RN II in Los Angeles to translate medical policies into accurate coding and claims logic. Requires an Associate's Degree in Nursing, 8+ years of clinical experience, and 3+ years in Medi-Cal/Medicare managed care. Key duties include developing codified cla...

L.A. Care Health Plan seeks a Care Management Specialist II in Los Angeles to manage complex cases for vulnerable populations. Requires an RN or LCSW with 3+ years of care management experience in managed care or hospice settings. Bilingual skills (Spanish, Chinese, Armenian, etc.) and CCM/ACM ce...

Seeking a detail-oriented **Utilization Management Clinical Quality Nurse Reviewer RN II** in **Los Angeles, CA**. Leverage 5+ years of clinical nursing and 2+ years of auditing experience to ensure **regulatory compliance** for Medi-Cal and Medicare. Conduct internal audits, lead pre/post extern...

Seeking a skilled **Utilization Management Nurse Specialist RN II** in **Los Angeles, CA**. This role requires an active California RN license, 5+ years of acute clinical experience, and 2+ years in UM/Case Management. You will coordinate referrals, perform concurrent reviews, and develop dischar...

Seeking an experienced Utilization Management RN II in Los Angeles. This role involves real-time clinical review of inpatient admissions and transfers, ensuring medical necessity and appropriate level of care. Requires 7+ years of acute hospital experience and UM expertise. We offer full benefits...

Seeking a Quality Management Nurse Specialist RN II in Los Angeles. This role leads clinical quality improvement projects and ensures compliance with key regulations like CMS and NCQA. Requires an active CA RN license, 5+ years of acute hospital experience, and strong analytical skills. We offer ...

Seeking a Utilization Management Nurse Specialist RN II in Los Angeles. This role requires an active California RN license, 5+ years of acute care experience, and 2+ years in UM/CM. You will coordinate referrals, perform admission reviews, and develop discharge plans. We offer comprehensive benef...