Utilization Management Nurse, LVN/LPN

Utilization Management Nurse, LVN/LPN - Conduct real-time clinical reviews to ensure medical necessity and appropriateness of healthcare services. Collaborate with healthcare providers, payers, and members to ensure compliance with health plan policies and clinical guidelines. Strong knowledge of clinical guidelines and medical necessity criteria is required.

Requirements

• Registered Nurse (RN) or Licensed Vocational/Practical Nurse (LVN/LPN) with an active, unrestricted California nursing license
• Minimum of 2-3 years of clinical nursing experience, with at least 1 year in utilization review, case management, or a related field
• Experience in a managed care setting with medical necessity reviews is strongly preferred
• Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), or Accredited Case Manager (ACM) certifications are preferred

Benefits

• Health benefits
• Life and disability benefits
• 401(k) savings plan with match
• Paid Time Off
• Paid holidays