California Licensed Utilization Review Nurse

Job Summary

Utilizing clinical judgment, the California Licensed Utilization Review Nurse will remotely approve or deny outpatient medical services based on Medical Necessity Criteria, working full-time with a schedule of five shifts per week, including weekends and holidays.

Key responsibilities

• Complete prior authorization and retrospective reviews for various medical services and equipment
• Refer cases to Medical Directors when necessary and maintain compliance with regulations and internal policies
• Perform additional duties as requested to support the Health Services Department

Required qualifications

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