Working Nurse
Los Angeles, CA
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...