Job Summary

A company is looking for a Utilization Management Nurse (LVN) for a remote administrative position with right to hire.

Key Responsibilities:

• Perform daily clinical reviews while patient is in the hospital/SNF
• Transfer members to an in-network hospital from an out-of-network ER/hospital

Required Qualifications:

• Clear and active LVN CA State license
• 2+ years of telephonic utilization review or management experience from acute care inpatient or hospital stay setting
• Experience with an MSO, health plan, or delegated risk arrangement
• Understanding of regulatory requirements such as Medicare, Medi-Cal, and Commercial/DMHC
• Computer savvy with Microsoft Office and strong skills with Excel; experience using Milliman or Interqual and EZ Cap 6 is a plus