Remote UM Nurse LPN for DMEPOS Utilization & Appeals

Integra Partners; Arizona; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Annual bonus

401(k) with employer match

Life insurance

Short-term disability

Medical, vision, and dental benefits

Paid holidays

Wellness programs

Remote opportunities

Job summary

Integra Partners seeks an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure medical necessity decisions align with NCQA-compliant UM programs, contributing to high-quality patient care.

Requires an active LPN/LVN license, 3+ years nursing experience, and 2+ years UM experience in a managed care setting, with familiarity in InterQual/CMS criteria.

Qualifications

• Active LPN/LVN license in good standing.
• 3+ years nursing in acute or outpatient settings.
• 2+ years UM experience in managed care.
• Experience with Medical Necessity Criteria (InterQual, CMS, health plan policies).
• Denial letters experience preferred.

Responsibilities

• Perform pre-service and post-service UM reviews using mandates, plan benefits, and criteria.
• Approve requests meeting eligibility, benefit, and medical necessity criteria.
• Refer cases to the Medical Director when criteria are not met.
• Process administrative and clinical appeals and refer as needed.
• Maintain NCQA/CMS/state accreditation compliance.
• Collaborate with Medical Director on utilization reviews.

Skills

LPN/LVN license

Nursing experience

UM experience

Medical necessity criteria

Denial letters experience

Job description

Integra Partners seeks an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure medical necessity decisions align with NCQA-compliant UM programs, contributing to high-quality patient care.

Requires an active LPN/LVN license, 3+ years nursing experience, and 2+ years UM experience in a managed care setting, with familiarity in InterQual/CMS criteria.