Remote LVN Utilization Review Nurse

Job Summary

A company is looking for a Remote LVN Utilization Review Nurse.

Key Responsibilities

• Conducts retrospective clinical reviews using InterQual guidelines for medical necessity
• Follows documented processes for the clinical appellate process and adheres to productivity and quality goals
• Performs follow-up on initial denials and ensures accurate diagnosis and procedure coding

Required Qualifications, Training, and Education

• High School Diploma or equivalent required
• Completion of an accredited RN or LVN program required
• Minimum of 3 years clinical practice experience required
• 2 years of utilization management and/or case management experience required
• Active, unrestricted State Registered Nursing license or Licensed Vocational Nursing license in good standing required