California Licensed Utilization Review Nurse
Job Summary
To support the Health Services Department, a California Licensed Utilization Review Nurse will work remotely to utilize clinical judgment in approving or denying outpatient medical services based on Medical Necessity Criteria, requiring at least one year of outpatient Utilization Management experience.
Key responsibilities
- Complete prior authorization and retrospective reviews for various medical services and equipment
- Refer cases to Medical Directors as necessary and maintain compliance with regulations and internal policies
- Perform additional duties as requested to support departmental needs
Required qualifications
- Active and unrestricted LVN license in California
- Minimum of one year of outpatient Utilization Management experience
- Proficiency in Microsoft applications such as Word, Excel, and Outlook
Complete Job Description
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