California Licensed Utilization Management Nurse

Job Summary

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

Key Responsibilities

• Evaluate and process prior authorization requests based on clinical guidelines
• Act as a liaison between healthcare providers, patients, and health plans to facilitate the authorization process
• Document all authorization activities accurately and maintain compliance with regulations

Required Qualifications

• Licensed Vocational/Practical Nurse (LVN/LPN) with an active, unrestricted California nursing license
• Minimum of 2-3 years of clinical nursing experience, including at least 1 year in utilization review or case management
• Experience in a managed care setting with medical necessity reviews is preferred
• Preferred certifications include Certified Professional in Utilization Review (CPUR) or Certified Case Manager (CCM)
• Additional clinical nursing or case management certifications are a plus