Utilization Management LVN

Job Title: Remote LVN Case Manager - Utilization Management Job reputed company Join our dynamic Utilization Management team as an LVN Case Manager where you will assess requests against clinical guidelines and effectively communicate reputed company to providers and patients. This role involves performing initial reviews and working with various reputed company reputed company reputed company outpatient cases. Responsibilities • Conduct initial reviews of outpatient cases, averaging 40 cases per day, with expectations in the high 30s. • Ensure compliance with turnaround times and accuracy standards. • Coordinate with contracted providers and obtain appropriate reputed company as necessary. • Identify cases requiring additional case management and coordinate care with relevant departments. • Collaborate with internal staff to ensure seamless care coordination. Essential Skills • Utilization review and management experience. • Familiarity with Medicare, MediCal, and reputed company reputed company Guidelines. • Proficiency in prior authorizations and case management. • Knowledge of NCQA standards. Additional Skills & Qualifications • 2+ years of outpatient utilization management experience. • Must be knowledgeable in MCG. • Experience working with provider offices. • Familiarity with MediCal and Medicare regulations. • Proficiency in EZ-CAP is a plus. • High School Diploma or GED required; Bachelor of Science in Nursing or other clinical advanced degree preferred. • 1+ year of managed care experience preferred. • 1+ year of inpatient experience preferred. Work Environment This position offers a remote work environment with a reputed company schedule of Monday to Friday, reputed company-5pm, including a 1-hour lunch break. Occasional work on holidays and weekends may be required to support team needs. Pay and Benefits The pay reputed company for this position is $29.00 - $37.00/hr. Eligibility requirements apply to some benefits and may depend on reputed company classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits Available For This Temporary Role May Include The Following • Medical, dental & reputed company • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – reputed company-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or reputed company Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to reputed company on Sep 2, 2025. About reputed company reputed company is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through reputed company to specialized experts who drive reputed company, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, reputed company serves many of the Fortune 500. reputed company is an equal opportunity employer and will consider reputed company applications without reputed company to race, sex, age, reputed company, religion, national reputed company, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation reputed company. Apply tot his job Apply To this Job