LPN Utilization Management Nurse

Job Summary

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

Key Responsibilities

• Perform pre-service and post-service UM authorization reviews based on medical necessity criteria
• Collaborate with the Medical Director for cases that do not meet medical necessity criteria and process appeals
• Maintain compliance with accrediting agency standards and communicate outcomes of reviews

Required Qualifications

• Active, Licensed Vocational Nurse or Licensed Practical Nurse license
• Minimum of 3 years of nursing experience in an acute or outpatient setting
• Minimum of 2 years of experience in utilization management within a managed care environment
• Experience with Medical Necessity Criteria and UM authorizations for DMEPOS is highly desirable
• Experience writing denial letters is preferred