Remote Utilization Management Nurse (LPN/LVN)

Integra Partners; Tennessee; Remote; USD 54,000 - 66,000; Full time

Benefits offered by this job

401(k) retirement program with company

Company-paid life insurance

Company-paid short term disability

Medical, Vision, and Dental benefits

Paid Time Off (PTO)

Paid Parental Leave

Sick Time

Paid company holidays

Quarterly company-sponsored events

Health and wellness programs

Career development opportunities

Job summary

Integra Partners is seeking a licensed practical nurse/licensed vocational nurse experienced in managed care to perform pre- and post-service utilization reviews for DMEPOS. You will collaborate with the Medical Director on benefit and medical necessity reviews within a NCQA-compliant UM program, handling appeals and communications with payors.

Salary offered is $60,000 annually. Remote nationwide opportunities are available for qualified candidates with strong UM background and healthcare

Qualifications

• Active LPN license in good standing.
• 3+ years nursing experience in acute or outpatient settings.
• 2+ years UM experience in managed care payor environment.
• Familiar with Medicare/Medicaid and DMEPOS UM authorizations and appeals.
• Ability to interpret medical necessity criteria (InterQual, CMS, health plan policies).

Responsibilities

• Perform pre-service and post-service UM authorization reviews using federal/state mandates, benefit language and criteria for medical necessity.
• Collaborate with non-clinical team to obtain additional clinical information as needed.
• Approve requests meeting eligibility, benefit and medical necessity criteria; refer others to Medical Director as needed.
• Refer cases to independent consultants/IROs when necessary; communicate outcomes verbally and in writing.
• Process administrative and clinical appeals; maintain NCQA CMS and state agency compliance.

Skills

UM experience

Nursing experience

Communication skills

Education

LPN licensure

Tools

InterQual

CMS guidelines

Job description

Integra Partners is seeking a licensed practical nurse/licensed vocational nurse experienced in managed care to perform pre- and post-service utilization reviews for DMEPOS. You will collaborate with the Medical Director on benefit and medical necessity reviews within a NCQA-compliant UM program, handling appeals and communications with payors.

Salary offered is $60,000 annually. Remote nationwide opportunities are available for qualified candidates with strong UM background and healthcare