California Licensed Utilization Review Nurse

A company is looking for a Utilization Review Nurse-LVN / LPN.

Key Responsibilities

Conduct first level reviews for outpatient and inpatient treatment requests for medical necessity

Process appeals for non-certification of services and complete necessary documentation

Collaborate with hospital staff for patient discharge and ensure a smooth transition to the next level of care

Required Qualifications

Current LVN license in the United States or U.S. territory

1+ years of clinical experience required

Knowledge of medical claims and ICD-10, CPT, HCPCS coding

Proficiency in Microsoft Office applications

Ability to meet productivity and quality standards daily