California Licensed Utilization Review Nurse

Job Summary

A company is looking for a UM Review Nurse to assist its Health Services Department.

Key Responsibilities

• Complete prior authorization and retrospective review of medical services
• Refer cases to Medical Directors as necessary
• Maintain knowledge of regulations and comply with internal policies

Required Qualifications

• Active and unrestricted LVN license in California
• Experience in outpatient utilization management (UM) required
• Experience with Microsoft applications such as Word, Excel, and Outlook
• Experience working with authorizations, referrals, or health insurance
• Two years of experience in health plan, UM, IPA, or MSO preferred