Prior Authorization LVN - Utilization Management Pro

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 Nurse (LVN) to perform clinical review and evaluation of authorization requests, ensuring medical necessity and proper utilization of services. The role involves coordination with providers, health plans, and internal teams to maintain CMS, NCQA, and organizational compliance.

The position requires a California LVN license (current and active) and at least one year of clinical experience, with preferred exposure to utilization

Qualifications

• High School diploma or equivalent; graduate from an accredited Vocational Nursing Program.
• Minimum: at least one year of clinical experience in a healthcare setting.
• Preferred: two or more years in utilization management, prior authorization, case management, or managed care.

Responsibilities

• Perform prospective, concurrent, and retrospective review of medical services to ensure medical necessity.
• Collaborate with providers, health plans, and internal clinical teams to support care coordination.
• Ensure compliance with CMS, NCQA, HIPAA and organizational guidelines.
• Serve as clinical resource to Prior Authorization Coordinators and utilize management systems.

Skills

Utilization management

Clinical documentation

Regulatory compliance

Communication skills

Multitasking

Team collaboration

Education

High School diploma, Vocational Nursing Program graduate

Job description

LaSalle Medical Associates IPA is seeking a Prior Authorization Nurse (LVN) to perform clinical review and evaluation of authorization requests, ensuring medical necessity and proper utilization of services. The role involves coordination with providers, health plans, and internal teams to maintain CMS, NCQA, and organizational compliance.

The position requires a California LVN license (current and active) and at least one year of clinical experience, with preferred exposure to utilization