Remote UM Nurse (LPN/LVN) — DMEPOS Appeals

Integra Partners; Central City (CO); Remote; USD 54,000 - 66,000; Full time

Benefits offered by this job

Competitive compensation and annual/bn

401(k) retirement program with company

Job summary

Integra Partners is seeking 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 NCQA-compliant UM programs and benefit determinations.

The role requires 3+ years nursing and 2+ years UM experience in managed care. Strong communication and documentation skills are essential in a dynamic team environment.

Qualifications

• Active LPN/LVN license in good standing.
• Minimum 3 years nursing in acute or outpatient setting.
• Minimum 2 years UM experience in managed care.
• Medicare/Medicaid experience desirable.
• UM authorizations and denials letters experience desirable.
• Strong written and verbal communication skills.
• Knowledge of NCQA, CMS guidelines and health policies.

Responsibilities

• Perform pre-service and post-service UM authorization reviews.
• Collaborate with Medical Director on benefit and medical necessity reviews.
• Process administrative and clinical appeals.
• Refer cases to Medical Director or external consultants when needed.
• Maintain compliance with NCQA, CMS and state standards.
• Communicate outcomes in writing and verbally.
• Coordinate with non-clinical team for additional information.

Skills

UM reviews

Medical necessity

Communication skills

CMS guidelines

InterQual criteria

Team collaboration

Documentation

Eligibility determination

DMEPOS knowledge

Compliance

Education

Licensed Practical Nurse license

Licensed Vocational Nurse license

Job description

Integra Partners is seeking 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 NCQA-compliant UM programs and benefit determinations.

The role requires 3+ years nursing and 2+ years UM experience in managed care. Strong communication and documentation skills are essential in a dynamic team environment.