Hybrid LVN Medical Case Manager — PACE Utilization

Norse Atlantic Airways; Orange (CA); Hybrid; USD 78,000 - 125,000; Full time

Benefits offered by this job

Partial Telework

Comprehensive benefits

CalPERS pension

Job summary

CalOptima Health is seeking a Licensed Vocational Nurse (LVN) for the PACE-Utilization Management team in California. You will review and authorize medical services, manage prior authorizations, and coordinate with providers while supporting patient-centered care.

The role includes partial telework with in-office presence in Orange, CA, at least two days weekly. Ideal candidates have 3+ years nursing experience (1 year reviewer) and a CA LVN license, with CPR/First-Aid certification or planned

Qualifications

• High school diploma or equivalent PLUS 3 years of nursing experience, with 1 year as a nurse reviewer; equivalent combo acceptable.
• CPR and First-Aid Certification required or must be obtained within six months of hire.

Responsibilities

• Review and process requests for authorization and notification of medical services.
• Utilize medical criteria and policies to authorize referrals and procedures.
• Communicate decisions with providers and document in the utilization management system.
• Verify CPT/HCPCS codes and ensure proper documentation for authorizations.

Skills

Nursing experience

Nurse reviewer

CPR/First-Aid

Communication

Computer skills

Education

High school diploma or equivalent

CA LVN license

Tools

MS Office

Utilization management system

Job description

CalOptima Health is seeking a Licensed Vocational Nurse (LVN) for the PACE-Utilization Management team in California. You will review and authorize medical services, manage prior authorizations, and coordinate with providers while supporting patient-centered care.

The role includes partial telework with in-office presence in Orange, CA, at least two days weekly. Ideal candidates have 3+ years nursing experience (1 year reviewer) and a CA LVN license, with CPR/First-Aid certification or planned