California Licensed Medical Management Specialist

Job Summary

A company is looking for a Medical Management Specialist, LVN.

Key Responsibilities

• Ensure timely and appropriate care for members, adhering to Medical Management policies
• Manage complex medical cases and coordinate care, including assessments and planning
• Maintain documentation and data entry in compliance with Medical Management policies

Required Qualifications

• Graduation from an accredited school of Licensed Vocational Nursing or equivalent experience
• Current and active California Licensed Vocational Nurse license required
• 3+ years of medical-surgical nursing experience
• 3+ years of Utilization Management/Prior Authorization experience in a managed care setting
• Knowledge of the California managed care industry and federal/state healthcare regulations