LVN, Utilization Management (Hybrid) – Impactful Care

California Nursing Students Association Incorporated; Montebello, Northern (CA, KY); Hybrid; USD 43,000 - 53,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Matching

Paid Time Off

Job summary

AltaMed Health Services Corp. in Montebello, CA is seeking a Licensed Vocational Nurse to perform Utilization Management, reviewing authorization requests and determining medical necessity for inpatient and outpatient services.

The UM Nurse will evaluate treatment plans against guidelines to ensure medical appropriateness and optimal coverage. A valid LVN license, 2 years of managed care UM experience, and BLS certification are required. Hybrid work and strong compensation offered.

Qualifications

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

Responsibilities

• Review authorization requests for medical necessity across lines of business.
• Evaluate proposed inpatient/outpatient treatment plans for coverage and efficiency.
• Determine medical appropriateness following guidelines and benefit determination.

Skills

Utilization Management

UM Review

Education

Licensed Vocational Nurse License

BLS Certification

Job description

AltaMed Health Services Corp. in Montebello, CA is seeking a Licensed Vocational Nurse to perform Utilization Management, reviewing authorization requests and determining medical necessity for inpatient and outpatient services.

The UM Nurse will evaluate treatment plans against guidelines to ensure medical appropriateness and optimal coverage. A valid LVN license, 2 years of managed care UM experience, and BLS certification are required. Hybrid work and strong compensation offered.