Working Nurse

Clinical Policy Clinical Coder RN II Shift: Full Time Pay Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Location: Los Angeles, 90017 Job Description The Clinical Policy Clinical Coder RN II is responsible for analyzing, interpreting, and operationalizing medical and utilization management policies to ensure accurate coding, appropriate authorization requirements, compliant claims processing, and effective utilization oversight. This position serves as a key clinical and coding resource, translating medical policy requirements into diagnosis, procedure, and service code logic, including determining which codes require prior authorization. Conducts in-depth research and analysis of legislation and regulatory requirements, clinical outcomes, utilization, claims, and financial data to identify utilization trends, fiscal risk, and opportunities for policy enhancement and cost containment. This position works cross‑functionally with internal teams to ensure...

Working Nurse in Los Angeles is seeking a Clinical Policy Clinical Coder RN II to ensure accurate medical coding and compliance with regulations. The role requires collaboration with stakeholders to implement policies and oversee utilization management. The ideal candidate has at least 8 years of clinical nursing experience, particularly with Medi-Cal and Medicare, and an Associate's degree in Nursing. This position offers a full-time shift with a competitive salary. #J-18808-Ljbffr