Remote Utilization Management Nurse (LPN/LVN)

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

Benefits offered by this job

Competitive compensation

Annual bonus program

Company-paid life insurance

Remote opportunities

401(k) with company match

Job summary

Integra Partners is seeking a licensed practical nurse (LPN/LVN) experienced in managed care to perform pre-service and post-service UM reviews and appeals for DMEPOS. The UM Nurse collaborates with the Medical Director for benefit and medical necessity determinations within an NCQA-compliant UM program.

The role requires active LPN/LVN licensure, at least 3 years of nursing experience in acute or outpatient settings, and at least 2 years in utilization management within a managed care payor

Qualifications

• Minimum 2 years of UM experience in a managed care, payor environment.
• Minimum 3 years of nursing in an acute or outpatient setting.
• Experience with Medical Necessity Criteria (InterQual, CMS guidelines, health plan policies).

Responsibilities

• Perform pre-service and post-service UM authorization reviews.
• Approve requests meeting eligibility and medical necessity criteria.
• Refer non-qualifying cases to Medical Director and process appeals as needed.
• Maintain compliance with NCQA, CMS and state standards.

Skills

UM experience

Nursing in acute/outpatient

Medical necessity interpretation

Documentation & denial letters

Education

LPN/LVN license

Job description

Integra Partners is seeking a licensed practical nurse (LPN/LVN) experienced in managed care to perform pre-service and post-service UM reviews and appeals for DMEPOS. The UM Nurse collaborates with the Medical Director for benefit and medical necessity determinations within an NCQA-compliant UM program.

The role requires active LPN/LVN licensure, at least 3 years of nursing experience in acute or outpatient settings, and at least 2 years in utilization management within a managed care payor