Impactful Denials Review Nurse — Utilization Management

UCLA Outpatient Clinics in Los Angeles is seeking a UM Denial Nurse Reviewer to apply clinical knowledge, policies, and regulatory guidelines to review adverse determinations and ensure accurate, timely notifications.

The role involves reviewing denials for proper documentation and criteria, providing clinical guidance, and collaborating with denial coordinators, prior authorization teams, and medical leadership to support appropriate denial determinations.