California Licensed Medical Management Specialist

Job Summary

To support a growing healthcare organization, the full-time California Licensed Medical Management Specialist will manage utilization processes for inpatient and outpatient care, ensuring compliance with medical policies and regulations while working remotely.

Key responsibilities

• Ensure timely and appropriate care services for members, adhering to Medical Management policies
• Conduct pre-service and concurrent reviews, collaborating with the Medical Director on complex cases
• Facilitate effective discharges from inpatient settings and manage urgent care needs for members outside the network

Required qualifications

• Graduation from an accredited school of Licensed Vocational Nursing or equivalent clinical experience
• Current and active California Licensed Vocational Nurse is required
• 3+ years of experience in medical-surgical nursing and Utilization Management/Prior Authorization
• Knowledge of California managed care industry and federal/state healthcare regulations
• Proficient in Microsoft Office Suite and possess strong analytical skills