Under the direction of the Assistant Director, the ICM Medicare Advantage Utilization Review Nurse performs utilization review of medical necessity and appropriateness, cost containment and efficiency, compliance with regulations and contracts, care coordination and continuity of care, prior authorization and denial management, education and provider support, and data and quality reporting for referrals for Medicare Advantage population enrolled under UCLA Medical Group. The ICM Medicare Advantage Utilization Review Nurse ensures that home health and durable medical equipment services are cost effective, timely, and compliant. This position is a vital role in balancing member quality care with efficient resource utilization under the UCLA Medical Group Utilization Management guidelines. In this role, you will work collaboratively with the patient, Faculty Practice Group, community resources, other providers, managed care operations, the UCLA Health System, and health plans to implement, identify, coordinate, and monitor options and services to meet at-risk patients' healthcare needs.