LVN Utilization Management Nurse
Pay: $38 – $45 per hour
Assignment Type: Temporary through the end of 2026
Location: Remote with initial onsite training and occasional onsite meetings in Montebello, CA
Position Overview
A managed care organization is seeking a Licensed Vocational Nurse (LVN) with Utilization Management experience to support authorization and medical necessity reviews across multiple lines of business.
The LVN UM Nurse will review authorization requests, evaluate treatment plans, and determine the medical appropriateness of inpatient and outpatient services using nationally recognized guidelines and health plan criteria.
Schedule
- Day Shift: 8:00 AM - 5:00 PM or 9:00 AM - 6:00 PM
Key Responsibilities
- Review and process authorization and referral requests within required turnaround times.
- Evaluate hospitalization, home health, inpatient, and outpatient services for medical necessity and efficiency.
- Apply evidence-based guidelines such as InterQual, Milliman, CMS, and health plan criteria.
- Verify member eligibility and benefits upon receipt of authorization requests.
- Enter and maintain accurate documentation in the medical management system.
- Communicate authorization decisions to providers and members in a timely manner.
- Collaborate with medical directors, hospital partners, and care teams to support appropriate care planning.
- Assist with LOA (Letter of Agreement) processing for non-contracted providers or facilities.
- Monitor ongoing services and recommend care plan adjustments when appropriate.
Minimum Qualifications
- Current and active Licensed Vocational Nurse (LVN) license
- Minimum 2 years of managed care experience
- Experience with prior authorizations, utilization review, or medical management
- Proficiency with electronic medical records and Microsoft Office (Word, Excel, Outlook)
- Strong communication, customer service, and problem-solving skills
- Knowledge of Medicare, Medi-Cal, Commercial, and government program authorization processes
Preferred Knowledge
- Familiarity with DOFRs and delegation agreements
- Experience using InterQual, Milliman, or other utilization review criteria
Work Environment
- Remote work with initial onsite training in Montebello, CA
- Occasional onsite meetings may be required.
- Primarily computer-based work requiring extended periods of sitting and data entry.
Pay: $38.00 - $45.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Life insurance
- Vision insurance
Application Question(s):
- Are you familiar with DOFRs and delegation agreements?
- Do you have experience using InterQual, Milliman, or other utilization review criteria?
- Are you comfortable commuting to Montebello, CA for occasional meetings and training?
Experience:
- Managed care: 2 years (Preferred)
- Prior authorization: 2 years (Preferred)
- Utilization management: 2 years (Preferred)
License/Certification:
- CA LVN License (Preferred)
Work Location: Hybrid remote in Montebello, CA 90640
