Remote Utilization Management Nurse (LPN/LVN) – Appeals Expert

Integra Partners; Phoenix (AZ); Vor Ort; USD 54.000 - 66.000; Vollzeit

Benefits dieser Stelle

Competitive compensation

Annual bonus program

401(k) with company match

Company-paid life insurance

Paid time off

Remote opportunities

Zusammenfassung

Integra Partners is seeking an LPN/LVN with experience in the managed care payor environment 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 program operations.

The role requires strong knowledge of medical necessity criteria, effective communication, and the ability to navigate complex benefit language and policies.

Qualifikationen

• Minimum of 3 years nursing in an acute or outpatient setting.
• Minimum of 2 years UM experience in managed care/payor environment.
• Experience with Medicare/Medicaid and DMEPOS UM authorizations is a plus.
• Experience writing denial letters is preferred.

Aufgaben

• Perform UM pre-service and post-service reviews to determine medical necessity.
• Collaborate with Medical Director on benefit and medical necessity reviews and appeals.
• Refer non-qualifying cases to Medical Director or external consultants when needed.
• Communicate outcomes of reviews clearly, in writing and verbally.

Kenntnisse

UM reviews

Medical necessity

NCQA compliance

InterQual CMS policies

Communication skills

Documentation

Ausbildung

LPN/LVN license

Jobbeschreibung

Integra Partners is seeking an LPN/LVN with experience in the managed care payor environment 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 program operations.

The role requires strong knowledge of medical necessity criteria, effective communication, and the ability to navigate complex benefit language and policies.