Nurse Auditor – Utilization Management & Denial Analytics

University of California - Los Angeles Health; Los Angeles (CA); On-site; USD 98,000 - 215,000; Full time

Job summary

University of California - Los Angeles Health is seeking an Utilization Management Nurse Auditor to provide clinical review, audits, and quality improvement support across the health system. You will conduct concurrent and retrospective reviews, support denials appeals, and analyze trends to drive utilization performance.

The role requires a California RN license, 5+ years in healthcare, and strong knowledge of payment and audit processes.

Qualifications

• Bachelor's degree in Nursing or allied healthcare field; applicable education/experience accepted.
• Five+ years of healthcare experience in clinical, quality improvement, utilization management, or related setting.
• Three+ years in utilization management, case management, or clinical auditing.
• Active, unrestricted RN license in California.
• Proficiency with UM criteria (InterQual/MCG) and payer requirements.
• Strong data analysis, reporting, and documentation skills.
• Excellent written and verbal communication; ability to work with physicians and leadership.
• Experience with electronic health records and reporting tools (Epic familiarity).
• Project management and organizational skills to handle multiple priorities.

Responsibilities

• Review concurrent and retrospective clinical denials to assess admission status and level of care.
• Prepare documentation for first- and second-level appeals and support payer/audit responses.
• Analyze denial trends to identify root causes and opportunities for improvement.
• Evaluate cases using utilization criteria and escalate complex cases as needed.
• Collaborate with physicians, care coordination, and Revenue Cycle to strengthen medical necessity support.
• Prepare dashboards, reports, and summaries for leadership and UM committee review.
• Support performance improvement initiatives focused on length of stay and denial rates.
• Serve as a clinical resource across the health system for utilization management and quality.

Skills

Utilization management

Clinical auditing

Data analysis

InterQual/MCG

Payer requirements

Project management

Communication

Collaboration

Epic

Quality improvement

Education

Bachelor's degree in Nursing

California RN license

Tools

Epic

Job description

University of California - Los Angeles Health is seeking an Utilization Management Nurse Auditor to provide clinical review, audits, and quality improvement support across the health system. You will conduct concurrent and retrospective reviews, support denials appeals, and analyze trends to drive utilization performance.

The role requires a California RN license, 5+ years in healthcare, and strong knowledge of payment and audit processes.