L.A. Care Health Plan - United States, Los Angeles, Nursing

Seeking an experienced **Supervisor, Utilization Management RN** in **Los Angeles, CA**. This role leads daily UM operations, supervises Care Management staff, and ensures optimal departmental efficiency. Requires an active California RN license, 7+ years of acute care experience, and 2+ years in...

MLTSS Nurse Specialist RN II needed in Los Angeles to apply advanced clinical judgment in managing long-term services for members with chronic conditions. Key duties include care coordination, UM authorizations, and telephonic follow-up. Requires an Associate's in Nursing and 3+ years of clinical...

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...

Appeals and Grievances Nurse Specialist RN II needed in Los Angeles. Investigate and resolve complex clinical member complaints and benefit coordination issues for a managed care health plan. Requires an active California RN license, 5+ years clinical experience, and 2+ years in Medicare/Medicaid...

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...