Licensed Vocational Nurse, Utilization Management

altamed; Montebello (CA); On-site; USD 43,000 - 53,000; Full time

Benefits offered by this job

Health insurance

403(b) retirement

Paid time off

Paid CME days

Tuition reimbursement

Employee discounts

Professional liability tail coverage

Job summary

AltaMed is seeking an LVN Utilization Management Nurse to review authorization requests for medical necessity across various lines of business. You will assess inpatient and outpatient plans for coverage guidance and efficiency, applying state and national guidelines.

The role requires an active LVN license, 2+ years in utilization management or prior authorization, and a valid BLS certification. Compensation reflects market ranges and includes potential discretionary bonuses; on-site in

Qualifications

• Active LVN license in good standing.
• Minimum of 2 years in utilization management / prior authorization.
• BLS certification (AHA or Red Cross) required.

Responsibilities

• Review authorization requests for medical necessity across lines of business.
• Assess inpatient/outpatient treatment plans for medical necessity and coverage guidelines.

Skills

Utilization Management

Prior Authorization

Managed Care Experience

Education

LVN License

Job 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.