Remote UM LPN — Medical Necessity & Appeals

Integra Partners; Tallahassee (FL); A distancia; USD 70.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

401(k) retirement plan with company‑mfl

Company-paid life insurance

Company-paid short term disability

Medical, Vision, and Dental benefits

Paid holidays and floating holidays

Health and wellness programs

Remote opportunities

Descripción de la vacante

Integra Partners seeks an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program. The role collaborates with our Medical Director to assess benefit and medical necessity across DMEPOS services.

Requirements include an active LPN/LVN license, 3+ years nursing in acute or outpatient settings, and 2+ years UM experience in managed care. Remote opportunities and competitive benefits are offered.

Formación

• Active LPN/LVN license is required.
• Minimum of 3 years nursing in an acute or outpatient setting.
• Minimum of 2 years of UM experience in a managed care, payor environment.
• Experience with Medical Necessity Criteria (InterQual, CMS guidelines, health plan policies).
• Experience writing denial letters is preferred.

Responsabilidades

• Perform pre-service and post-service UM authorization reviews using federal/state mandates, plan benefit language, and NCDs/LCDs to determine medical necessity.
• Approve requests that meet eligibility, benefit, and medical necessity criteria.
• Refer cases to the Medical Director that do not meet medical necessity criteria.
• Process administrative and clinical appeals and refer as needed.
• Maintain compliance with NCQA, CMS and state accrediting standards.

Conocimientos

UM experience in managed care/payor

Nursing in acute or outpatient setting

Educación

Licensed Vocational Nurse / Licensed Practical Nurse license

Descripción del empleo

Integra Partners seeks an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program. The role collaborates with our Medical Director to assess benefit and medical necessity across DMEPOS services.

Requirements include an active LPN/LVN license, 3+ years nursing in acute or outpatient settings, and 2+ years UM experience in managed care. Remote opportunities and competitive benefits are offered.