Remote Utilization Management Nurse (LPN/LVN) - DMEPOS

Integra Partners; Crystal Bay (NV); Remote; USD 54,000 - 66,000; Full time

Benefits offered by this job

Bonus program

401(k) matching

Life insurance

Disability coverage

Medical/Dental/Vision

Job summary

Integra Partners seeks an LPN/LVN experienced in managed care UM to perform pre- and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director on benefit and medical necessity reviews within an NCQA-compliant UM program.

Salary: $60,000.00 annual. Join a national DMEPOS network focused on quality outcomes and efficient benefits management.

Qualifications

• Active LPN/LVN license required.
• Minimum 3 years nursing in acute or outpatient settings.
• Minimum 2 years UM experience in managed care/payor env.
• Experience with Medicare/Medicaid preferred.
• Experience with UM authorizations and appeals for DMEPOS preferred.
• Proven knowledge of medical necessity criteria.

Responsibilities

• Perform UM pre-service and post-service reviews for medical necessity.
• Collaborate with Medical Director on benefit and reviews.
• Approve eligible requests and refer non-eligible cases.
• Communicate outcomes verbally and in writing.
• Maintain NCQA, CMS, and state compliance.
• Process administrative and clinical appeals as needed.

Skills

UM reviews

DMEPOS knowledge

InterQual criteria

CMS guidelines

Medical record review

Communication skills

Team collaboration

Caseload management

Education

LPN/LVN license

Job description

Integra Partners seeks an LPN/LVN experienced in managed care UM to perform pre- and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director on benefit and medical necessity reviews within an NCQA-compliant UM program.

Salary: $60,000.00 annual. Join a national DMEPOS network focused on quality outcomes and efficient benefits management.