Prior Authorization LVN - Care Coordination

LaSalle Medical Associates IPA; San Bernardino (CA); On-site; USD 48,000 - 55,000; Full time

Job summary

LaSalle Medical Associates IPA is seeking a Prior Authorization LVN to perform clinical review and ensure medical necessity under CMS, NCQA, and HIPAA guidelines.

The role requires California LVN licensure, strong knowledge of utilization management, and the ability to collaborate with providers and health plans. This full-time position offers exposure to a multidisciplinary team and efficient care coordination in a fast-paced environment.

Qualifications

• High school diploma or equivalent; LVN diploma or certificate
• At least 1 year clinical experience; knowledge of medical terminology
• Experience with utilization management and prior authorization
• Familiarity with CMS, NCQA, HIPAA requirements

Responsibilities

• Perform clinical review of authorization requests to ensure medical necessity
• Conduct prospective, concurrent, and retrospective reviews
• Collaborate with providers and health plans to support care coordination
• Maintain regulatory and organizational guidelines

Skills

Utilization management

Medical terminology

Regulatory compliance

Communication skills

Education

High School diploma or equivalent

Graduate from an accredited Vocational Nursing Program

Tools

EMR systems

MS Office

Job description

LaSalle Medical Associates IPA is seeking a Prior Authorization LVN to perform clinical review and ensure medical necessity under CMS, NCQA, and HIPAA guidelines.

The role requires California LVN licensure, strong knowledge of utilization management, and the ability to collaborate with providers and health plans. This full-time position offers exposure to a multidisciplinary team and efficient care coordination in a fast-paced environment.