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California Licensed Utilization Management Nurse
A company is looking for a Utilization Management Nurse (Work from Home). Key Responsibilities Perform medical necessity reviews for an assigned panel of members Collaborate with the Medical Director on adverse determination notices Ensure timely discharge planning and communication to transition of care teams Required Qualifications, Training, and Education Associate's degree in Nursing preferred Minimum 2 years of experience in medical management clinical functions Working knowledge of MCG, InterQual, and NCQA standards Active License as a Licensed Vocational Nurse (LVN) in California Certification in Managed Care Nursing (CMCN) preferred
A company is looking for a Utilization Management Nurse (Work from Home).
Key Responsibilities
Perform medical necessity reviews for an assigned panel of members
Collaborate with the Medical Director on adverse determination notices
Ensure timely discharge planning and communication to transition of care teams
Required Qualifications, Training, and Education
Associate's degree in Nursing preferred
Minimum 2 years of experience in medical management clinical functions
Working knowledge of MCG, InterQual, and NCQA standards
Active License as a Licensed Vocational Nurse (LVN) in California
Certification in Managed Care Nursing (CMCN) preferred