California State Licensed Utilization Management Nurse
Company: VirtualVocations
Location: Montgomery
Posted on: September 17, 2023
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Job Description:
A company is looking for a Utilization Management Nurse (LVN)
for a remote administrative position.
Key Responsibilities:
Performing daily clinical reviews while patients are in the
hospital/SNF
Transferring members to an in-network hospital from an
out-of-network ER/hospital
Required Qualifications:
Clear and active LVN CA State license
2+ years of telephonic utilization review/management experience
from an acute care/inpatient/hospital stay setting (not payor
side)
Experience with an MSO, Health Plan, or Delegated Risk
arrangement
Understanding of regulatory requirements such as Medicare,
Medi-Cal, and Commercial/DMHC
Computer savvy with Microsoft Office, strong skills in Excel;
experience using Milliman or Interqual, EZ Cap 6 is a plus
Keywords: VirtualVocations, Montgomery , California State Licensed Utilization Management Nurse, Executive , Montgomery, Alabama
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