California Licensed Utilization Review Nurse

Job Summary

Seeking a California Licensed Utilization Review Nurse, this remote full-time position will manage outpatient medical service approvals and denials based on Medical Necessity Criteria while maintaining compliance with regulations and internal policies.

Key responsibilities

• Complete prior authorization and retrospective reviews for various medical services and equipment
• Refer cases to Medical Directors as necessary and maintain knowledge of relevant regulations
• Perform additional duties as requested while ensuring compliance with internal policies

Required qualifications

• Active and unrestricted LVN license in California
• At least 1 year of outpatient Utilization Management experience
• Proficiency in Microsoft applications, including Word, Excel, and Outlook