SCAN Health Plan
Medical Management Specialist, LVN
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Job Description
- Req#: JR1124
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Base salary range up to $44.52 per hour
- Annual employee bonus program
- Remote work flexibility
- Robust wellness program and generous paid time off (PTO)
- Excellent 401(k) retirement savings plan with employer match
- Opportunity to make a meaningful difference in the lives of older adults
What to Expect (Job Responsibilities):
- Support the quality, medical necessity, and cost-effectiveness of care and services based on regulatory guidelines and medical policy
- Conduct pre-service and concurrent reviews in collaboration with the Medical Director
- Manage complex medical cases using case management and utilization management principles
- Facilitate safe and effective discharges from inpatient settings and communicate member needs to the care team
- Maintain documentation and adhere to Medical Management policies and procedures
What is Required (Qualifications):
- Graduation from an accredited school of Licensed Vocational Nursing or equivalent clinical experience
- Current and active California Licensed Vocational Nurse (LVN) license
- Minimum of 3 years of experience in medical-surgical nursing
- Minimum of 3 years of Utilization Management/Prior Authorization experience in a managed care setting
- Proficient in Microsoft Word, Excel, Outlook, and PowerPoint
How to Stand Out (Preferred Qualifications):
- Certified Professional of Utilization Management (CPUM or CPUR) or willingness to obtain within 2 years
- Knowledge of California managed care industry, Medicare/Medi-Cal, and healthcare mandates
- Strong analytic and problem-solving skills
- Ability to multitask and work in a fast-paced environment
- ICD-9, HCPCS, and CPT coding knowledge
#HealthcareServices #MedicareAdvantage #RemoteWork #CareerGrowth #NursingOpportunityAbout the company
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