Licensed Vocational Nurse, Utilization Management

AltaMed • Montebello, CA

90d • $31 - $38

About The Position

The LVN, Utilization Management Nurse position will provide routine review of authorization requests from all lines of business using respective national/state, health plans, and nationally recognized guidelines. Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency with coverage guidelines. The UM Nurse determines the medical appropriateness of inpatient and outpatient services following the evaluation of medical guidelines and benefit determination.

Requirements

• Graduated from an accredited LVN school.
• Current LVN license issued by the State of California Vocational Nursing.
• Minimum of 2 years of managed care experience.
• BLS Certification.

Responsibilities

• Review authorization requests from all lines of business.
• Evaluate proposed hospitalization, home care, and treatment plans for medical necessity.
• Determine medical appropriateness of inpatient and outpatient services.
• Follow national/state guidelines and health plan coverage guidelines.

Benefits

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: Associate degree
• Number of Employees: 1,001-5,000 employees