Denial LVN

LSMA Management Inc • San Bernardino, CA

4d • $35 - $40 • Onsite

About The Position

The Denial Review LVN supports the Utilization Management and Denial Compliance functions by assisting with the review, auditing, and correction of denial documentation to ensure compliance with applicable regulatory, contractual, and accreditation standards. Working within the scope of an LVN license, this role focuses on denial language accuracy, timeliness, and completeness, while providing education and support to medical group staff under established policies and procedures.

Requirements

• High school diploma or equivalent required.
• Graduate of an accredited Licensed Vocational Nursing program.
• 1+ years of LVN experience in a healthcare setting.
• Current, active, unrestricted California LVN license required.
• Knowledge of basic utilization management and denial processes.
• Familiarity with managed care and regulatory environments (e.g. NCQA, DMHC, CMS).
• Ability to interpret guidelines and apply standardized criteria with direction.
• Strong written and verbal communication skills.
• Attention to detail and ability to audit documentation for compliance.
• Ability to manage multiple tasks and meet deadlines.
• Proficiency with electronic health records and standard office software.
• Professional, collaborative, and adaptable work style.

Nice To Haves

• Training or coursework related to utilization management, managed care, or healthcare compliance.
• Experience in utilization review, denial management, managed care, or healthcare compliance.

Responsibilities

• Assist with the review, auditing, and correction of denial documentation.
• Ensure compliance with applicable regulatory, contractual, and accreditation standards.
• Focus on denial language accuracy, timeliness, and completeness.
• Provide education and support to medical group staff.
• Operate within the scope of an LVN license and established policies and procedures.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree