California Licensed Medical Management Specialist

Job Summary

To support the quality and cost-effectiveness of care, the full-time California Licensed Medical Management Specialist (LVN) will manage utilization processes, conduct medical reviews, and coordinate care for members while working remotely from California.

Key responsibilities

• Ensure timely and appropriate inpatient and outpatient care for SCAN members while adhering to Medical Management policies
• Manage complex medical cases through assessment, planning, and coordination, and participate in interdisciplinary team meetings
• Assist members in accessing urgent medical services and facilitate safe discharges from inpatient settings

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 in a managed care setting
• Knowledge of California managed care industry and federal/state healthcare regulations
• Proficient in Microsoft Office Suite and possess strong analytic and problem-solving skills