Nurse, (LVN) Utilization Mngmt

Job Description

Work Boldly. Live Brilliantly.

At AltaMed, we don’t just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challenges because this is more than a job. It’s the calling of our lives and it compels us to keep moving forward.

Job Overview

The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization requests from all lines of business using respective national/state, health plan, nationally recognized guidelines. Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency with coverage guidelines. The UM Nurse determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.

Minimum Requirements

1. Current valid License as a Licensed Vocational Nurse.

2. Minimum of 2 years of managed care experience

3. Demonstrated ability to work with automated systems, including electronic medical records and MS Office products such as Word, Excel and Outlook.

4. Excellent customer service; ability to be an effective communicator

5. Knowledge of federal, state and other applicable standards for clinical practice for assigned area(s) of responsibility.

6. Ability to work collaboratively with diverse individuals and situations, including strong problem solving and conflict resolution skills.

Benefits & Career Development

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance