Utilization Management Nurse - LPN LVN

Location: Remote
Compensation: Salary
Staff Reviewed: Fri, Feb 09, 2024
This job expires in: 15 days

Job Summary

A company is looking for a Utilization Management Nurse - LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS.

Key Responsibilities:
  • Perform pre-service and post service UM authorization reviews utilizing federal and state mandates, plan benefit language and NCDs/LCDs as criteria for medical necessity reviews
  • Refer cases to the Medical Director that do not meet medical necessity criteria and refer cases to independent consultants or IROs, when necessary
  • Process administrative and clinical appeals and maintain compliance with all accrediting agency standards such as NCQA, CMS and State agencies

Required Qualifications:
  • Active, Licensed Vocational Nurse, or Licensed Practical Nurse license
  • Minimum of 3 years of nursing in an acute or outpatient setting and minimum of 2 years of UM experience in a managed care, payor environment
  • Experience with Medical Necessity Criteria including but not limited to InterQual, CMS guidelines, health plan medical policies, etc
  • Experience with Medicare and Medicaid (not required, but highly desirable) and experience with UM authorizations and appeals for DMEPOS (not required, but highly desirable)

COMPLETE JOB DESCRIPTION

The job description is available to subscribers. Subscribe today to get the full benefits of a premium membership with Virtual Vocations. We offer the largest remote database online...

BECOME A PREMIUM MEMBER TO
UNLOCK FULL JOB DETAILS & APPLY

  • ACCESS TO FULL JOB DETAILS AND APPLICATION INFORMATION
  • HUMAN-SCREENED REMOTE JOBS AND EMPLOYERS
  • COURSES, GROUP CAREER COACHING AND RESOURCE DOWNLOADS
  • DISCOUNTED CAREER SERVICES, RESUME WRITING, 1:1 COACHING AND MORE
  • EXCELLENT CUSTOMER SUPPORT FOR YOUR JOB SEARCH