A company is looking for a Utilization Management Nurse, LVN / LPN.
Key Responsibilities
Conduct timely reviews of inpatient and skilled nursing services to assess medical necessity and appropriateness
Collaborate with the Medical Director on complex cases and provide comprehensive clinical summaries
Process authorization requests and communicate with healthcare providers regarding treatment plans
Required Qualifications
Education : Active, unrestricted California nursing license as an RN or LVN / LPN; BSN preferred
Experience : 2-3 years of clinical nursing experience, with at least 1 year in utilization review or case management
Certifications : Preferred certifications include CPUR, CCM, or ACM
Experience in a managed care setting with medical necessity reviews is strongly preferred
Strong knowledge of clinical guidelines and medical necessity criteria
California Licensed Utilization Review Nurse • Davie, Florida, United States
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