LVN, Preservice Review Nurse - Remote

For those who want to invent the future of health care, here's your opportunity. We're going reputed company basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The Prior Authorization LVN ensures that prior authorization requests from patients and providers are completed in a timely fashion to meet the contractual and regulatory requirements while acting reputed company the scope of the Board of Vocational Nursing and Psychiatric Technicians of the State of California. The Prior Authorization LVN will promote the quality and cost effectiveness of medical care provided to patients by applying clinical acumen and using appropriate nationally recognized guidelines, criteria, and evidence based standards. Also assists UM management and Compliance team in preparation for audits and other regulatory activities as needed. If you are licensed in California, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Responsible for screening and reviewing prospective, reputed company, and retrospective referrals and authorizations for medical necessity and appropriateness of service and care and discussing with Medical Directors Coordinate health care services with appropriate physicians, facilities, contracted providers, ancillary providers, allied health professionals, funding sources and community resources Responsible for the prospective review to determine appropriateness of denial, possible alternative treatment, and draft denial language to ensure consistent application of standardized, nationally recognized UM criteria and appropriate use of denial language Coordinate out -of- network and out - of - area cases with member, health plans and Case Management team Review s patient referrals reputed company the specified care management policy timeframe (Type and Timeline Policy) reputed company and maintain effective working relationships, with physicians and office staff Demonstrates a thorough understanding of the cost consequences resulting from care management reputed company through utilization of appropriate reports such as Health Plan Eligibility and Benefits and Division of Responsibility (DOR) Maintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients, and families You ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as reputed company development for other roles you may be interested in. Required Qualifications: Graduation from an accredited Licensed Vocational Nurse program Active, unrestricted LVN license in the state of California 2 years of clinical experience in an acute or ambulatory patient care setting including one year in a managed care environment such as a medical group, independent physician association, or health plan 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 experience in a Managed Care setting reputed company employees working remotely will be required to adhere to reputed company s Telecommuter Policy California Residents Only: The hourly reputed company for this role is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you ll find a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone of every race, gender, sexuality, age, location and income deserves the opportunity to live their healthiest life. 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