California Licensed Concurrent Review Nurse

Job Summary

A company is looking for a Concurrent Review Nurse, LVN/LPN (Work from Home).

Key Responsibilities:

• Conduct real-time clinical reviews to assess medical necessity and appropriateness of healthcare services
• Collaborate with the Medical Director on complex cases and facilitate communication with healthcare providers and payers
• Ensure compliance with health plan policies and maintain accurate documentation of review activities

Qualifications:

• Licensed Vocational/Practical Nurse (LVN/LPN) with an active California nursing license; BSN preferred
• Minimum of 2-3 years of clinical nursing experience, with at least 1 year in utilization review or case management
• Experience in a managed care setting with medical necessity reviews is strongly preferred
• Preferred certifications include Certified Professional in Utilization Review (CPUR) or Certified Case Manager (CCM)
• Strong knowledge of clinical guidelines and medical necessity criteria