LVN/LPN Utilization Review Nurse

Job Summary

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

Key Responsibilities

• Provide clinical assessment and review for medical necessity of treatment requests and care plans
• Conduct comprehensive reviews for outpatient and inpatient pre-certification requests
• Facilitate care transitions and connect members to case management and wellness resources

Required Qualifications

• Current unrestricted LVN/LPN license required
• 2-3 years clinical nursing experience required
• 1 year recent experience in Utilization Review or Utilization Management preferred
• Knowledge of medical claims, ICD-10, CPT, and HCPCS coding
• Proficiency in Microsoft Office applications