LVN - Utilization Review & Quality Assurance

cvhp; Covina (CA); On-site; USD 43,000 - 64,000; Full time

Job summary

Emanate Health in Covina, CA is seeking an experienced Utilization Review Nurse to evaluate medical records and determine medical necessity under applicable policies and guidelines. The role requires clinical judgment and documentation of decisions using protocol sets and guidelines.

The position demands a minimum of three years in utilization management, excellent customer service, and a current California LVN license. Pay range is $31.03–$46.54 per hour.

Qualifications

• Minimum of three years of utilization management experience.
• Experience in quality-related roles preferred.
• Current California LVN license.
• Excellent customer service skills required.

Responsibilities

• Evaluate medical records to determine medical necessity using clinical guidelines and policy.
• Document decisions using indicated protocol sets or clinical guidelines.
• Provide support and review of medical claims and utilization practices; refer to Medical Directors when needed.

Skills

Utilization management

Customer service

Computer proficiency

Job description

Emanate Health in Covina, CA is seeking an experienced Utilization Review Nurse to evaluate medical records and determine medical necessity under applicable policies and guidelines. The role requires clinical judgment and documentation of decisions using protocol sets and guidelines.

The position demands a minimum of three years in utilization management, excellent customer service, and a current California LVN license. Pay range is $31.03–$46.54 per hour.