Remote Utilization Management Nurse (LPN/LVN)

Integra Partners; United States; A distancia; USD 54.000 - 66.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive compensation

401(k) with company match

Company-paid life insurance

Short term disability

Medical, Vision, and Dental

PTO

Parental Leave

Sick Time

Holidays & floating holidays

Quarterly events

Wellness programs

Career development opportunities

Descripción de la vacante

Integra Partners is seeking an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program. The role collaborates with the Medical Director to assess benefit and medical necessity for DMEPOS.

The position offers competitive compensation with benefits, remote opportunities across multiple states, and potential annual bonus. Healthcare professionals with UM experience in managed care are encouraged to apply.

Formación

• Minimum 2 years of UM experience in a managed care environment.
• Active LPN/LVN license required.
• Experience with Medicare/Medicaid and DMEPOS is a plus.
• Strong verbal and written communication; ability to convey information clearly.

Responsabilidades

• Perform pre-service and post-service UM authorization reviews using plan benefits, criteria, and guidelines.
• Collaborate with Medical Director to perform benefit and medical necessity reviews and appeals.
• Refer non-qualifying cases to Medical Director or independent consultants as needed.
• Communicate outcomes of UM reviews in writing and verbally; support appeals process.
• Maintain NCQA CMS and state accreditation standards; stay adaptable in a fast-paced environment.

Conocimientos

UM experience

LPN/LVN

Medicare/Medicaid knowledge

Communication skills

NCQA compliance

Educación

LPN/LVN license

Descripción del empleo

Integra Partners is seeking an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program. The role collaborates with the Medical Director to assess benefit and medical necessity for DMEPOS.

The position offers competitive compensation with benefits, remote opportunities across multiple states, and potential annual bonus. Healthcare professionals with UM experience in managed care are encouraged to apply.