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2 um nurse jobs at 2 companies in Calimesa, CA

2mo
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UM Nurse Reviewer
Orange, California, United States
$75k-$95k/yr OnsiteFull Time
Astiva Health
Astiva Health: Medicare Advantage HMO health plan serving seniors through culturally responsive, community-based care in Southern California.
3+ YOEActive unrestricted LVN license, 3+ years clinical nursing experience, preferably in utilization management or managed care; knowledge of MCG, InterQual, Medicare, Medicaid, CMS, HIPAA, and NCQA requirements.
Milliman Care Guidelines (MCG), InterQual, Medicare, Medicaid, CMS, HIPAA, NCQA
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3mo
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Clinical Review Nurse - Prior Authorization
Pomona, California, United States
$62k-$94k/yr OnsiteFull Time
Akido Labs
Akido Labs: Private AI-native healthcare delivering primary, specialty, and safety-net care through its medical network.
3+ YOEActive California LVN or RN license; 3-5+ years clinical UM review; prior authorization in managed care; knowledge of MCG criteria; EZCap experience preferred; California DMHC/CMS knowledge.
EZCap, MCG guidelines
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