Remote Jobs
Medical Management Specialist, LVN
What's your preference?
Job Description
- Req#: JR1956
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Base salary range: up to $44.52 per hour
- Annual employee bonus program
- Robust Wellness Program and generous paid time off (PTO)
- Excellent 401(k) Retirement Saving Plan with employer match
- Remote work opportunity allowing for a flexible work-life balance
- Chance to make a positive impact on the wellbeing of older adults in the community
What to Expect (Job Responsibilities):
- Ensure timely and appropriate inpatient and outpatient care for SCAN members in adherence to Medical Management policies
- Collect and apply evidence-based criteria and guidelines for optimal outcomes and cost-effectiveness in care delivery
- Manage complex medical cases through assessment, planning, implementation, and coordination of services
- Assist members in urgent and emergent situations to ensure quality and coordinated care
- Maintain documentation and communication standards while building effective professional relationships with providers and partners
What is Required (Qualifications):
- Graduation from an accredited school of Licensed Vocational Nursing or equivalent clinical experience
- Current and active California Licensed Vocational Nurse certification
- A minimum of 3 years of experience in medical-surgical nursing
- A minimum of 3 years of Utilization Management/Prior Authorization experience in a managed care setting
- Proficiency 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 certification within 2 years
- Knowledge of the California managed care industry and Medicare/MediCal
- Strong analytic and problem-solving skills
- Ability to multitask in a fast-paced environment
- Experience with ICD-9, HCPCS, and CPT coding
#HealthcareServices #SeniorCare #RemoteWork #CareerOpportunity #UtilizationManagement #NursingJobs
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
The best remote jobs for you
Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report. NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.