Remote Utilization Management Nurse (LPN/LVN) – DMEPOS

Integra Partners; Nevada; On-site; USD 54,000 - 66,000; Full time

Benefits offered by this job

401(k) retirement program with company

Company-paid life insurance

Short term disability coverage

Medical, Vision, and Dental benefits

Paid Time Off

Paid Parental Leave

Sick Time

Paid holidays and floating holidays

Quarterly company-sponsored events

Health and wellness programs

Career development opportunities

Job summary

Integra Partners is seeking an LPN/LVN with managed care UM experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure benefits and medical necessity decisions meet NCQA standards.

Qualified candidates hold an active LVN license, at least 3 years nursing experience, and 2 years UM experience in a payor environment. Knowledge of Medicare/Medicaid is a plus.

Qualifications

• Active LVN license required.
• Minimum 3 years nursing in acute or outpatient setting.
• Minimum 2 years UM experience in managed care/payor environment.
• Experience with Medical Necessity Criteria (InterQual, CMS, health plan policies).

Responsibilities

• Perform pre-service and post-service UM authorization reviews.
• Collaborate with Medical Director on benefit and medical necessity decisions.
• Communicate outcomes of UM reviews verbally and in writing.
• Process administrative and clinical appeals as needed.
• Refer non-qualifying cases to Medical Director or IROs.
• Maintain NCQA/CMS/state accreditation compliance.

Skills

UM reviews

Medical necessity

Documentation

Team collaboration

Education

Active LVN license

Tools

InterQual criteria

CMS guidelines

Job description

Integra Partners is seeking an LPN/LVN with managed care UM experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure benefits and medical necessity decisions meet NCQA standards.

Qualified candidates hold an active LVN license, at least 3 years nursing experience, and 2 years UM experience in a payor environment. Knowledge of Medicare/Medicaid is a plus.