Remote LPN Utilization Management Nurse — UM & Appeals

Integra Partners Holdings, Inc.; United States; À distance; USD 65 000 - 95 000; Plein temps

Résumé du poste

Integra Partners Holdings, Inc. is seeking a full-time remote LPN Utilization Management Nurse to perform pre-service and post-service utilization reviews for DMEPOS, ensuring NCQA standards and medical necessity criteria.

The role collaborates with the Medical Director to review authorizations, communicate outcomes, and support appeals. It requires strong UM experience in managed care and familiarity with InterQual and CMS guidelines.

Qualifications

• Active LPN or LVN license
• Minimum 3 years of nursing experience in acute or outpatient settings
• At least 2 years of utilization management experience in managed care
• Familiarity with medical necessity criteria (InterQual, CMS)
• Experience with UM authorizations and appeals for DMEPOS is highly desirable

Responsabilités

• Conduct pre-service and post-service UM authorization reviews based on federal and state mandates and benefit language
• Communicate outcomes of UM authorization reviews and process administrative and clinical appeals as needed
• Maintain compliance with accrediting agency standards and collaborate with non-clinical teams to gather necessary clinical information

Connaissances

UM nursing experience

LPN/LVN license

CMS/InterQual familiarity

DMEPOS knowledge

Description du poste

Integra Partners Holdings, Inc. is seeking a full-time remote LPN Utilization Management Nurse to perform pre-service and post-service utilization reviews for DMEPOS, ensuring NCQA standards and medical necessity criteria.

The role collaborates with the Medical Director to review authorizations, communicate outcomes, and support appeals. It requires strong UM experience in managed care and familiarity with InterQual and CMS guidelines.