Prior Authorization LVN – Clinical Reviewer & Care Coordinator

LSMA Management, Inc.; San Bernardino (CA); On-site; USD 48,000 - 55,000; Full time

Job summary

LSMA Management, Inc. is seeking a Prior Authorization Nurse (LVN) in California to perform clinical reviews of authorization requests, ensuring medical necessity and regulatory compliance.

The role involves prospective, concurrent, and retrospective reviews across specialty care and diagnostics, coordinating with providers and health plans. The successful candidate will have a California LVN license and at least one year of clinical experience, with strong documentation and communication skills

Qualifications

• Minimum: High School diploma or equivalent; graduate from an accredited Vocational Nursing Program.
• Minimum: at least one year of clinical experience; knowledge of medical terminology, utilization management processes, and clinical care practices.
• Preferred: two+ years in utilization management, prior authorization, case management, or managed care experience; experience in MSO/IPA/health plan environments; knowledge of ICD-10, CPT, HCPCS; experience with EMR and utilization management systems.
• Certification: Current, active, unrestricted California LVN license.

Responsibilities

• Perform clinical review and evaluation of authorization requests.
• Ensure medical necessity and regulatory compliance.
• Conduct prospective, concurrent, and retrospective reviews of medical services.
• Collaborate with providers, health plans, and internal clinical teams.
• Support utilization management operations and serve as a clinical resource to coordinators.

Skills

Utilization mgmt

Medical necessity

Regulatory knowledge

Clinical communication

MS Office

EMR systems

Team collaboration

Prior authorization

Documentation

Attention to detail

Education

High School diploma or equivalent

Graduate from Vocational Nursing Program

Tools

MCG

InterQual

EHR software

Authorization systems

Job description

LSMA Management, Inc. is seeking a Prior Authorization Nurse (LVN) in California to perform clinical reviews of authorization requests, ensuring medical necessity and regulatory compliance.

The role involves prospective, concurrent, and retrospective reviews across specialty care and diagnostics, coordinating with providers and health plans. The successful candidate will have a California LVN license and at least one year of clinical experience, with strong documentation and communication skills