California Licensed Utilization Review LVN

Job Summary

To support effective management of managed care patients, the full-time California Licensed Utilization Review LVN will work remotely to assess the appropriateness and medical necessity of referrals, manage patient charts, and coordinate high-quality care interventions.

Key responsibilities

• Manages assigned referral queues daily to ensure compliance with established timeframes
• Determines referral types and applies correct criteria for reviews, maintaining high accuracy in documentation
• Prepares cases for physician review by researching relevant medical information and monitoring treatment outcomes

Required qualifications

• Three (3) years of Utilization Management (UM) experience
• Five (5) years of LVN experience
• Clear and current California Licensed Vocational Nurse (LVN) license
• Strong knowledge of nursing requirements in a clinical setting
• Ability to apply clinical judgment and manage multiple priorities in a fast-paced environment