Job Summary:
Join our team as a Licensed Vocational Nurse (LVN) - Preservice Review Nurse, working remotely, and be part of shaping the future of healthcare. We are seeking a highly skilled LVN to join our team, focusing on prior authorization reviews, ensuring timely and accurate assessments that meet contractual and regulatory requirements.
Key Responsibilities:
- Screen and review referrals and authorizations for medical necessity and appropriateness of service and care, collaborating with Medical Directors as needed.
- Coordinate healthcare services with physicians, facilities, providers, and community resources.
- Conduct prospective reviews to determine appropriateness of denial, alternative treatment, and draft denial language.
- Manage out-of-network and out-of-area cases with members, health plans, and Case Management teams.
- Develop and maintain effective relationships with physicians, office staff, and other stakeholders.
- Demonstrate understanding of cost consequences of care management decisions and maintain effective communication with health plans, physicians, hospitals, and patients.
Requirements:
- Graduation from an accredited Licensed Vocational Nurse program.
- Active, unrestricted LVN license in California.
- 2+ years of clinical experience in an acute or ambulatory patient care setting, including 1 year in a managed care environment.
- Ability to work 8-5PM PST.
Preferred Qualifications:
- 3+ years of experience working as an LVN/LPN.
- 2+ years of care management, utilization review, or discharge planning experience.
- Experience in an HMO or Managed Care setting.
What We Offer:
- Competitive salary ($19.47 - $38.08 per hour for California residents).
- Comprehensive benefits package.
- Incentive and recognition programs.
- Equity stock purchase and 401k contribution.
About Us:
At UnitedHealth Group, we are committed to helping people live healthier lives and making the health system work better for everyone. We value diversity, equity, and inclusion, and strive to create a workplace that is welcoming and inclusive for all employees.
How to Apply:
If you are a motivated and compassionate LVN looking to make a difference in healthcare, we encourage you to apply for this exciting opportunity.
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