Utilization Management Nurse (LPN/LVN) - Remote

integrapartners; United States; Remote; USD 54,000 - 66,000; Full time

Benefits offered by this job

401(k) retirement program with company

Company-paid life insurance

Medical, Vision, and Dental benefits

Paid Time Off (PTO)

Paid Parental Leave

Sick Time

Company holidays and floating holidays

Wellness programs

Career development opportunities

Job summary

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 for DMEPOS. The role collaborates with our Medical Director to assess benefit and medical necessity, in a fast-paced environment across the United States.

Qualified nurses with UM experience in managed care are encouraged to apply. We offer competitive compensation with annual bonus, comprehensive benefits, and opportunities for career

Qualifications

• Active LPN or 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, policies).
• Experience with UM authorizations and appeals for DMEPOS is desirable.

Responsibilities

• Perform pre-service and post-service UM authorization reviews using mandates and plan language.
• Collaborate with non-clinical team to obtain additional clinical information as needed.
• Approve requests that meet eligibility, benefit, and medical necessity criteria.
• Refer cases to Medical Director or IROs when not meeting criteria.
• Communicate outcomes of UM reviews verbally and in writing.
• Maintain NCQA, CMS, and state accreditation standards.

Skills

UM reviews

Medical necessity

Communication skills

NCQA/CMS knowledge

DMEPOS familiarity

Education

LPN license

Job description

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 for DMEPOS. The role collaborates with our Medical Director to assess benefit and medical necessity, in a fast-paced environment across the United States.

Qualified nurses with UM experience in managed care are encouraged to apply. We offer competitive compensation with annual bonus, comprehensive benefits, and opportunities for career