Description: The Judge Group is currently seeking a Case Manager LVN (Prior Auth) for a fantastic client of our in Orange, CA!
Below, you can find a brief overview of the opportunity. If you would be interested to apply, or would know anyone interested, please feel free to reach out to me at jmaybrier@judge.com!
This job will have the following responsibilities:
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Reviews requests for medical appropriateness.
Verifies and processes specialty referrals, diagnostic testing, outpatient procedures, home health care services and durable medical equipment and supplies via telephone or fax by using established clinical protocols to determine medical necessity.
Screens requests for Medical Director review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director's decision and documents follow-up in the utilization management system.
Qualifications & Requirements:
Current, unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California required.
3 years of nursing experience required; 1 year of which must be as a Clinical Nurse Reviewer.
1 year of utilization management/prior authorization review experience required.
Again, if you would be interested to apply or would like more information, please dont hesitate to reach out to me at jmaybrier@judge.com
Thank You,
Jacob
Contact: jmaybrier@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
