California Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Management Nurse, LVN/LPN.

Key Responsibilities

• Conduct timely reviews of inpatient and skilled nursing services to assess medical necessity and appropriateness
• Collaborate with the Medical Director on complex cases and provide comprehensive clinical summaries
• Process authorization requests and communicate with healthcare providers regarding treatment plans

Required Qualifications

• Education: Active, unrestricted California nursing license as an RN or LVN/LPN; BSN preferred
• Experience: 2-3 years of clinical nursing experience, with at least 1 year in utilization review or case management
• Certifications: Preferred certifications include CPUR, CCM, or ACM
• Experience in a managed care setting with medical necessity reviews is strongly preferred
• Strong knowledge of clinical guidelines and medical necessity criteria