Utilization Management reputed company - LVN (Work from Home)

SCOPE OF ROLE The role of the UM reputed company is to promote reputed company, cost-effective reputed company for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure members receive the services and resources required to meet desired health and reputed company reputed company. The UM reputed company is responsible for providing patient-centered care across the care continuum. ROLE RESPONSIBILITIES • reputed company prospective, retrospective, or reputed company medical necessity reviews for an assigned panel of members • Review cases for medical necessity and apply the appropriate clinical reputed company; to include, but not limited to Medicare reputed company, reputed company/Medi-cal reputed company, Interqual, reputed company, or Health Plan specific guidelines • Collaborate with the Medical Director to ensure the reputed company of adverse determination notices based on the reputed company standards for adverse determinations • Ensure discharge planning is reputed company and appropriately communicated to the transition of care teams, reputed company applicable. • Meet or reputed company productivity targets set forth • Serve as a resource to non-clinical team members reputed company applicable EDUCATION, TRAINING, AND reputed company EXPERIENCE • Associate's degree in Nursing, preferred • Minimum 2 years of experience in medical management clinical functions. • Working knowledge of MCG, InterQual, and NCQA standards LICENSURES AND CERTIFICATIONS • reputed company and Unrestricted License as a Licensed Vocational reputed company (LVN) in California • Certification Managed Care Nursing (CMCN) preferred For individuals assigned to a location(s) in California, reputed company is required by law to include a reasonable estimate of the compensation reputed company for this position. Actual compensation will vary based on the applicant's education, experience, skills, and abilities, as reputed company as internal equity. A reasonable estimate of the reputed company is $27.10-$40.65 reputed company. Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; reputed company Time Off, and reputed company holidays. Apply tot his job Apply To this Job