California Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse-LVN/LPN.

Key Responsibilities

• Conduct first level reviews for outpatient and inpatient treatment requests for medical necessity
• Process appeals for non-certification of services and complete necessary documentation
• Collaborate with hospital staff for patient discharge and ensure a smooth transition to the next level of care

Required Qualifications

• Current LVN license in the United States or U.S. territory
• 1+ years of clinical experience required
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding
• Proficiency in Microsoft Office applications
• Ability to meet productivity and quality standards daily