California Licensed Utilization Management LVN

Job Summary

To support a growing healthcare team, the full-time California Licensed Utilization Management LVN will manage authorization processes, perform utilization reviews, and collaborate with healthcare providers and insurance representatives in a remote setting.

Key responsibilities

• Interface with external agencies regarding the utilization management process, including health plans and medical providers
• Perform utilization review activities for hospital admissions and outpatient services, ensuring timely reporting to stakeholders
• Assist medical directors with benefit interpretation and provide case discussions as needed

Required qualifications

• California LVN licensure required
• 2 years of recent relevant experience in utilization management or a similar field
• Familiarity with healthcare reimbursement systems and value-based reimbursement models preferred
• Experience with MCG or InterQual guidelines highly desired
• Knowledge of ICD-9, CPT, and HCPCS coding preferred