SCAN Health Plan
Medical Management Specialist, LVN
6 days agoWhat's your preference?
Job Description
- Req#: JR1956
Employer Industry: Healthcare Services
Why Consider this Job Opportunity:
- Salary up to $44.52 per hour
- Opportunity for annual employee bonus program
- Robust wellness program and generous paid time off (PTO)
- Excellent 401(k) retirement savings plan with employer match
- Remote work flexibility with a focus on work-life balance
- Chance to make a positive impact on members and the community
What to Expect (Job Responsibilities):
- Support the quality, medical necessity, and cost-effectiveness of care based on regulatory guidelines
- Manage utilization management processes related to coverage decisions and service requests
- Conduct pre-service and concurrent reviews in collaboration with the Medical Director
- Assist members requiring urgent medical and behavioral health services outside the network
- Maintain documentation and data entry requirements following Medical Management policies
What is Required (Qualifications):
- Graduation from an accredited school of Licensed Vocational Nursing or equivalent clinical experience
- Current and active California Licensed Vocational Nurse required
- 3+ years of experience in medical-surgical nursing
- 3+ years of Utilization Management/Prior Authorization experience in a managed care setting
- Strong verbal and written communication skills
How to Stand Out (Preferred Qualifications):
- Certified Professional of Utilization Management (CPUM or CPUR) or willingness to attain certification within 2 years
- Knowledge of California managed care industry and Medicare/MediCal
- Proficient in Microsoft Word, Excel, Outlook, and PowerPoint
- Strong analytic and problem-solving skills
- ICD-9, HCPCS, and CPT coding knowledge
#HealthcareServices #NursingJobs #CareerOpportunities #RemoteWork #EqualOpportunityEmployment
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