California Licensed Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse - LVN (Work from Home).

Key Responsibilities

• Perform medical necessity reviews for assigned members
• Collaborate with the Medical Director on adverse determination notices
• Ensure timely discharge planning and communication with care teams

Required Qualifications, Training, and Education

• Associate's degree in Nursing, preferred
• Minimum 2 years of experience in medical management clinical functions
• Working knowledge of MCG, InterQual, and NCQA standards
• Active and Unrestricted License as a Licensed Vocational Nurse (LVN) in California
• Certification in Managed Care Nursing (CMCN) preferred