L.A. Care Health Plan - Nursing, On-site work

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 detail-oriented **Utilization Management Claims Review Nurse RN II** in **Los Angeles, CA**. This role conducts clinical reviews of medical claims for medical necessity, accuracy, and compliance, supporting payment integrity and FWA prevention. Requires an active **California RN license...

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 skilled **Utilization Management Nurse Specialist RN II** in **Los Angeles, CA**. Requires an active California RN license, 5+ years of acute clinical experience, and 2+ years in UM/Case Management. You will coordinate referrals, conduct concurrent reviews, and develop discharge plans. ...

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 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...