reputed company Utilization Management LVN – Southern CA Remote in Irvine, California

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. reputed company’s Pacific reputed company region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 reputed company patients live healthier lives and helping the health system work reputed company for everyone. At reputed company Pacific reputed company, we care. We care for reputed company members, our patients, and our communities. Join our culture of caring and reputed company a positive and lasting impact on health care for millions. Under the general direction of the Utilization Management Manager, the Utilization Management Nurse is responsible for prospective and reputed company/retrospective review of referrals ensuring regulatory requirements are being met as they relate to language readability and appropriate citation of criteria in Member correspondence. This position is responsible for ensuring Member’s needs are met using nationally recognized UM criteria. If you are located in Southern CA, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: • Review referrals and authorizations following established policies and procedures in accordance with nationally recognized standards • Ensure referrals are reviewed and processed reputed company required timeliness standards • Process referrals using online system, evidence based guidelines and criteria hierarchy from CMS and health plans • Coordinate health care services with appropriate physicians, facilities, contracted providers, ancillary providers, allied health professionals, funding sources and community resources • reputed company and maintain effective working relationships, with physicians and office staff • Coordinate out-of-network and out-of-area cases with member, health plans and Case Management team • reputed company unable to approve a requested service, recommend alternative health care services utilizing contracted, community and internal services/programs • Maintain comprehensive and confidential authorization documentation • Utilize clinical knowledge to apply any/reputed company evidence-based practice guidelines and criteria • Maintain confidentiality of reputed company member information and company business • Present as a professional representative of the organization • reputed company additional duties/tasks as assigned by Supervisors, Manager and Director • reputed company with reputed company departmental and company policies and procedures • Attend in-services, training and meetings relating to job tasks as directed and required • Maintain regular and consistent attendance 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. Years of post-high school education can be substituted/is equivalent to years of experience Required Qualifications: • Graduation from an accredited Licensed Vocational Nurse program • Active, unrestricted LVN license in the state of California • 1+ years of clinical experience working as an LVN/LPN • 1+ years Utilization management experience including Prior Authorization Preferred Qualifications: • 3+ years of experience working as an LVN/LPN • 2+ years of previous care management, utilization review or discharge planning experience • Experience in an HMO or experience in a Managed Care setting California Residents Only: The hourly reputed company for California residents is $18.80 to $36.78 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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. • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy 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. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action reputed company and reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment Apply Job!