Remote LPN UM Nurse: Managed Care & Appeals

Integra Partners; Yuma (AZ); Remote; USD 52,000 - 80,000; Full time

Benefits offered by this job

Competitive compensation and annualBON

401(k) retirement with company match

Company-paid life insurance

Short term disability coverage

Medical, Vision, Dental benefits

Paid holidays and floating holidays

Health and wellness programs

Remote Opportunities

Job summary

Integra Partners is seeking an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals in a managed care UM environment. The role collaborates with the Medical Director to ensure benefit and medical necessity reviews meet NCQA-compliant UM standards.

The UM Nurse will review pre/post service requests against plan benefit language, NCDs/LCDs, and criteria such as InterQual, CMS policies, and other medical policies.

Qualifications

• Active LPN/LVN license in good standing.
• Minimum 3 years nursing experience in acute or outpatient settings.
• Minimum 2 years UM experience in managed care.
• Experience with InterQual, CMS guidelines, and health plan policies.

Responsibilities

• Perform pre-service and post-service UM reviews based on federal/state mandates.
• Approve eligible requests; refer non-qualifying cases to Medical Director.
• Process administrative and clinical appeals.
• Maintain NCQA, CMS, and state accrediting standards.
• Collaborate with Medical Director on benefit determinations.

Skills

LPN/LVN

UM experience

Medical Director collab

Plan benefit knowledge

Education

Licensed Practical Nurse license

Job description

Integra Partners is seeking an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals in a managed care UM environment. The role collaborates with the Medical Director to ensure benefit and medical necessity reviews meet NCQA-compliant UM standards.

The UM Nurse will review pre/post service requests against plan benefit language, NCDs/LCDs, and criteria such as InterQual, CMS policies, and other medical policies.