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Medical Management Specialist, LVN
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Job Description
- Req#: JR1124
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Base salary up to $44.52 per hour
- 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
- Opportunity to make a positive impact on the health and well-being of seniors in the community
What to Expect (Job Responsibilities):
- Support the quality, medical necessity, and cost-effectiveness of care based on regulatory guidelines and medical policy
- Conduct pre-service and concurrent reviews in collaboration with the Medical Director
- Manage complex medical cases and prepare case presentations for interdisciplinary team meetings
- Assist members in accessing urgent and emergent medical and behavioral health services
- Maintain documentation and data entry requirements adhering to all 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 license
- 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 such certification within 2 years
- Knowledge of the California managed care industry and Medicare/MediCal
- Proficient in Microsoft Word, Excel, Outlook, and PowerPoint
- ICD-9, HCPCS, and CPT coding knowledge
#HealthcareServices #VocationalNursing #RemoteWork #CareerOpportunity #EmployeeBenefits
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