LVN Nurse Reviewer - Utilization Management (Onsite)

Universal Healthcare IPA, Inc.; Bakersfield (CA); On-site; USD 43,000 - 74,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Simple IRA Plan

Employer Paid Life Insurance

Employee Assistance Program

Job summary

Universal Healthcare IPA, Inc. is seeking an UM Nurse Reviewer in Bakersfield, CA. This on-site, full-time role focuses on efficient pre-certification and concurrent reviews to ensure appropriate care and timely discharges.

The ideal candidate holds an active CA RN or LVN license with at least one year in managed care or utilization management, plus strong communication and analytical skills. Competitive hourly pay with benefits is offered.

Qualifications

• Active unrestricted California RN or LVN license.
• At least one year of managed care or utilization management experience.
• Proficient in PC software and EMR systems.
• Knowledge of ICD-10 and CPT coding preferred.
• Excellent verbal and written communication with strong analytical skills.

Responsibilities

• Performs utilization review including pre-certification, concurrent, and retrospective reviews.
• Reviews proposed hospitalizations and treatment plans for medical necessity per CMS guidelines.
• Determines medical necessity using established criteria and guidelines.
• Documents all utilization review activities and communicates outcomes to providers and members.
• Participates in audits, quality improvement initiatives, and education of staff.

Skills

Managed care experience

Utilization management

Communication skills

Analytical skills

Team collaboration

Education

RN or LVN license (CA)

Tools

EMR software

Job description

Universal Healthcare IPA, Inc. is seeking an UM Nurse Reviewer in Bakersfield, CA. This on-site, full-time role focuses on efficient pre-certification and concurrent reviews to ensure appropriate care and timely discharges.

The ideal candidate holds an active CA RN or LVN license with at least one year in managed care or utilization management, plus strong communication and analytical skills. Competitive hourly pay with benefits is offered.