Licensed Vocational Nurse, Utilization Management

AltaMed Health Services; Montebello (CA); Hybrid; USD 43,000 - 54,000; Full time

Benefits offered by this job

Medical, Dental and Vision insurance

403(b) Retirement savings plans with 1

Flexible Spending Accounts

Paid Time Off & Holidays

Paid CME Days

Malpractice tail coverage

Tuition Reimbursement

Employee Discounts

Job summary

AltaMed Health Services seeks a Licensed Vocational Nurse (LVN) for Utilization Management in Montebello, CA. The UM Nurse will review authorization requests for medical necessity and efficiency using national/state guidelines, determining medical appropriateness for inpatient and outpatient services.

Two years of managed care UM/prior authorization experience and a current LVN license with a valid BLS certification are required.

Qualifications

• Current valid LVN license.
• Minimum of 2 years of managed care experience in Utilization Management/prior authorization.
• A valid BLS certification or higher per AHA/Red Cross guidelines.

Responsibilities

• Review authorization requests from all lines of business for medical necessity and efficiency.
• Determine medical appropriateness of inpatient and outpatient services following guidelines and benefit determinations.

Skills

Utilization Management

Prior authorization

BLS certification

Education

Licensed Vocational Nurse (LVN) license

Job description

Position Title

Licensed Vocational Nurse, Utilization Management

Location

Montebello, CA 90640

Description

Grow Healthy

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.

Job Overview

The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization requests from all lines of business using respective national/state, health plan, 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 evaluation of medical guidelines and benefit determination.

Minimum Requirements

• Current valid License as a Licensed Vocational Nurse.
• Minimum of 2 years of managed care experience in Utilization Management/prior authorization required.
• A minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines.

Compensation

$31.05 - $38.82 hourly

Compensation Disclaimer

Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.

Benefits & Career Development

• 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

Job Advertisement & Application Compliance Statement

AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

Remote Type

Hybrid

About US

As the nation’s largest Federally Qualified Health Center (FQHC), AltaMed is at the forefront of providing affordable, high-quality health care to underserved communities in Los Angeles and Orange Counties. At AltaMed, you will have the opportunity to work with a diverse team of dedicated professionals who are passionate about making a difference and supporting our community of over 400,000 patients.

Equal Employment Opportunity Statement

AltaMed Health Services Corporation is committed to providing equal employment opportunities for all qualified individuals. We strictly prohibit discrimination in employment based on race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin, age, medical condition, physical or mental disability, military or protected veteran status, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical conditions, genetic information, or any other characteristic protected by local, state, or federal law, ordinance, or regulation.

We are committed to promoting equality and inclusivity beyond our recruitment and hiring processes. We aim to create a respectful, valued, and inclusive workplace through training, advancement opportunities, and access to resources and support. We focus on fostering a diverse workforce because it enriches our organization and improves our ability to effectively serve our clients and community. We encourage individuals from all backgrounds to apply and join us in our mission to create a positive impact.

Equal employment opportunity, including veterans and individuals with disabilities.