Utilization Review Nurse

To support a growing healthcare team, the full-time California Licensed Utilization Management LVN will manage authorization processes, perform utilization reviews, and collaborate with healthcare providers and insurance representatives in a remote setting. Key responsibilities Interface with external agencies regarding the utilization management process, including health plans and medical providers Perform utilization review activities for hospital admissions and outpatient services, ensuring timely reporting to stakeholders Assist medical directors with benefit interpretation and provide case discussions as needed Required qualifications California LVN licensure required 2 years of recent relevant experience in utilization management or a similar field Familiarity with healthcare reimbursement systems and value-based reimbursement models preferred Experience with MCG or InterQual guidelines highly desired Knowledge of ICD-9, CPT, and HCPCS coding preferred