LVN , Preservice Review Nurse - Remote - 2247530 El Segundo, CA 10/11/2024 Nursing
About the position Responsibilities • Screen and review prospective, concurrent, and retrospective referrals and authorizations for medical necessity and appropriateness of service. • Coordinate health care services with physicians, facilities, contracted providers, and community resources. • Determine appropriateness of denial and draft denial language based on standardized UM criteria. • Coordinate out-of-network and out-of-area cases with members and health plans. • Review patient referrals within specified care management policy timeframes. • Develop and maintain effective working relationships with physicians and office staff. • Understand cost consequences of care management decisions using appropriate reports. • Maintain effective communication with health plans, physicians, hospitals, and patients. Requirements • Graduation from an accredited Licensed Vocational Nurse program. • Active, unrestricted LVN license in the state of California. • 2+ years of clinical experience in an acute or ambulatory patient care setting, including one year in a managed care environment. • Ability to work 8-5 PM PST. Nice-to-haves • 3+ years of experience working as an LVN/LPN. • 2+ years of care management, utilization review, or discharge planning experience. • Experience in an HMO or Managed Care setting. Benefits • Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution Apply tot his job