Remote UM Nurse LPN — Utilization Review & Appeals

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

Benefits offered by this job

Remote Opportunities

Company-paid life insurance

401(k) retirement program

Job summary

Integra Partners is seeking an LPN/LVN with UM experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with the Medical Director to ensure benefit and medical necessity reviews align with NCQA standards within a UM program.

Responsibilities include reviewing requests, approving those meeting criteria, and referring others to the Medical Director. The role supports a remote workforce across the United States and offers competitive

Qualifications

• Active LPN/LVN license (or equivalent) and current licensure.

Responsibilities

• Perform pre-service and post-service UM authorization reviews using mandates, plan language, and criteria for medical necessity.

Skills

UM experience

Medical necessity reviews

Authorization reviews

InterQual

CMS guidelines

Education

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

Tools

NCQA standards

Job description

Integra Partners is seeking an LPN/LVN with UM experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with the Medical Director to ensure benefit and medical necessity reviews align with NCQA standards within a UM program.

Responsibilities include reviewing requests, approving those meeting criteria, and referring others to the Medical Director. The role supports a remote workforce across the United States and offers competitive