Remote LPN Utilization Review Nurse – Managed Care

Integra Partners; Colorado Springs (CO); Remote; USD 52,000 - 76,000; Full time

Benefits offered by this job

Competitive compensation and annualBON

401(k) retirement program with company

Company-paid life insurance

Company-paid short term disability

Medical, Vision, and Dental benefits

Paid company holidays and floating saw

Remote Opportunities

Job summary

Integra Partners is seeking a licensed LPN/LVN with managed care UM experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure medical necessity reviews align with NCQA standards.

The UM Nurse will review requests using InterQual and CMS guidelines, approve eligible cases, and refer others to the Medical Director. Remote opportunities are available across the United States.

Qualifications

• Active, Licensed Vocational Nurse, or Licensed Practical Nurse license.
• Minimum of 3 years of nursing in an acute or outpatient setting.
• Minimum of 2 years of UM experience in a managed care environment.
• Experience with medical necessity criteria such as InterQual and CMS guidelines.
• Experience writing denial letters is preferred.

Responsibilities

• Perform pre-service and post-service UM authorization reviews based on mandates, plan language, and criteria.
• Approve requests that meet eligibility and medical necessity criteria.
• Refer cases to Medical Director when criteria are not met.
• Process administrative and clinical appeals as needed.
• Maintain NCQA, CMS and state accreditation compliance.

Skills

UM experience

Medical necessity criteria

NCQA compliance

Education

Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)

Tools

InterQual

CMS guidelines

Job description

Integra Partners is seeking a licensed LPN/LVN with managed care UM experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure medical necessity reviews align with NCQA standards.

The UM Nurse will review requests using InterQual and CMS guidelines, approve eligible cases, and refer others to the Medical Director. Remote opportunities are available across the United States.