Utilization Management LVN — Elevate Care & Approvals

Altais Health Solutions; California (MO); Hybrid; USD 75,000 - 89,000; Part time

Benefits offered by this job

Medical coverage

401k match

Paid time off / holidays

Job summary

Altais Health Solutions seeks a Utilization Management LVN in California for a dynamic, collaborative team. The role focuses on efficient authorization processes and advocating for patient-centered care.

You will work with Ambulatory and Concurrent Care, Network Management, and other teams to ensure medical necessity and accurate documentation. Required California LVN licensure and 2 years of relevant experience, with familiarity in reimbursement models and coding systems.

Qualifications

• LVN with California Licensure.
• 2 years of relevant experience preferred.
• Awareness of reimbursement models incl. HMO, PPO, CMS, etc.
• Experience with ICD-9, CPT and HCPCS codes preferred.

Responsibilities

• Drive efficient utilization management processes and authorizations.
• Interpret benefits and research medical necessity information.
• Collaborate with Ambulatory, Network Management, and Quality Improvement teams.
• Ensure accuracy of case data (ICD-10, CPT, HCPCS) in Tapestry.
• Provide guidance on medical necessity and policy adherence.

Skills

Licensed Vocational Nurse

Education

CA LVN License

Job description

Altais Health Solutions seeks a Utilization Management LVN in California for a dynamic, collaborative team. The role focuses on efficient authorization processes and advocating for patient-centered care.

You will work with Ambulatory and Concurrent Care, Network Management, and other teams to ensure medical necessity and accurate documentation. Required California LVN licensure and 2 years of relevant experience, with familiarity in reimbursement models and coding systems.