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Licensed Vocational Nurse – Utilization Management
| Company | AltaMed Health Services |
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| Location | Montebello, CA, USA |
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| Salary | $31.93 – $31.93 |
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| Type | Full-Time |
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| Degrees | |
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| Experience Level | Mid Level |
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Requirements
- Current valid License as a Licensed Vocational Nurse.
- Minimum of 2 years of managed care experience in Utilization Management/prior authorization required.
- A minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines.
Responsibilities
- Provide routine review of authorization requests from all lines of business using respective national/state, health plan, and nationally recognized guidelines.
- Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency with coverage guidelines.
- Determine the medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
Preferred Qualifications
No preferred qualifications provided.
