LVN Utilization Management

Job Summary

A company is looking for a Utilization Management LVN (Licensed Vocational Nurse) to support the UM team by conducting medical necessity reviews and coordinating authorizations.

Key Responsibilities

• Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and appropriateness of care
• Collaborate with RNs, physicians, and other clinical staff to ensure coordinated, timely reviews
• Maintain accurate documentation of clinical reviews, determinations, and communications in the system

Required Qualifications

• Active and unrestricted LVN license in an eNLC state with multistate privileges
• 3+ years of Nursing experience
• 1+ years of Utilization Management experience
• Familiarity with medical terminology and utilization management guidelines
• Proficiency in Microsoft Office and experience with healthcare systems or electronic medical records