• UM Prior Authorization…

    UCLA Health (Los Angeles, CA)
    …is responsible for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital...of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity… more
    UCLA Health (10/03/25)
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  • Utilization Management LVN

    WelbeHealth (Los Angeles, CA)
    …and gaps in participants' charts with authorizations in the UM system + Review prior authorization requests for medical necessity and alignment with ... participants. The Utilization Management LVN is accountable for the review and audit of authorization requests to...Minimum of one (1) year of chart auditing or UM review experience + Knowledgeable in areas… more
    WelbeHealth (12/12/25)
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  • RN Case Manager - Value Based Service Org - Full…

    University of Southern California (Alhambra, CA)
    …major duties of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate patient status is ... assigned upon admission and prior to discharge; InterQual or MCG reviews are completed...1. Demonstrates sound clinical knowledge base regarding CM standards, UM standards, clinical standards of care, NCQA requirements, CMS… more
    University of Southern California (11/19/25)
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  • Utilization Management Representative I

    Elevance Health (Los Angeles, CA)
    …**Utilization Management Representative I** is responsible for coordinating cases for precertification and prior authorization review . **How you will make an ... provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the… more
    Elevance Health (12/11/25)
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