Utilization Management LVN for Highly Regarded Healthcare Company in Orange County Posted Date: August 24, 2021

Job Description

An exciting and lucrative opportunity just became available for an experienced Licensed Vocational Nurse to work for a highly regarded healthcare company in Orange County. The LVN will be working in the Utilization Management department.

Job Description:

? Responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, commercial lines of business, clinical facilities and ancillary providers.
? Focused on reviewing complex and/or costly authorization requests (many cancer treatments, new meds, procedures and technologies)
? Responsible for tasks/functions related to prior authorization and referral. Actively participating in telephone on-line responsibilities as well as selected off-line tasks/functions.
? Responsible for applying medical criteria and policies/procedures to authorization or referral requests from medical professionals, clinical facilities and ancillary providers.
? Directly interact with provider callers, acting as a resource for their needs. UM experience needed.
? Reviews ICD-10, CPT-4 and HCPCS codes for accuracy and existence of coverage specific to the line of business.

Experience & Education:

? Current, unrestricted LVN license
? 3+ years of Clinical Experience
? 1+ years of Utilization Management/ Prior Authorization Review experience required.
? Strong knowledge of Commercial Lines, Medicare and Medi-Cal guidelines

Schedule: Monday - Friday (8 am to 5pm)

Start Date: ASAP

Interview: Phone ALL's WELL is proud to be an Equal Opportunity Employer. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment qualified applicants with arrest and conviction records.

Experience Required

, , ,