California Licensed Medical Management Specialist

Job Summary

To support quality care for members, the full-time California Licensed Medical Management Specialist will manage utilization processes, conduct reviews, and coordinate complex medical cases while working remotely in California.

Key responsibilities

• Ensure timely and appropriate inpatient and outpatient care for SCAN members, adhering to Medical Management policies
• Manage complex medical cases through assessment, planning, and coordination, participating in interdisciplinary team meetings
• Facilitate effective discharges from inpatient settings and address urgent member care issues through established processes

Required qualifications

• Graduation from an accredited school of Licensed Vocational Nursing or equivalent clinical experience
• Current and active California Licensed Vocational Nurse license 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