LVN, Utilization Management - Remote - 2249754 El Segundo, CA 11/08/2024 Nursing
About the position Responsibilities • Prepares and submits pre-audit documentation as outlined on Health Plan audit tools. • Communicates with Health Plan auditors related to audit documents and processes. • Collaborates across the organization to gather necessary documentation to meet audit requirements. • Facilitates onsite/virtual/desktop compliance audit reviews to ascertain regulatory requirements adherence. • Participates in performance improvement activities. • Conducts comprehensive internal audits of the end-to-end utilization management process. • Conducts focused internal audits of specific elements or process changes based on identified trends or new process implementation. Requirements • Graduation from an accredited Licensed Vocational/Practical Nurse program or completion of vocational nursing program through the CA Board of Nursing. • Current LVN/LPN license. • 2+ years of clinical experience working as an LVN/LPN. • 1+ years of utilization management experience, especially in Prior Authorization. Nice-to-haves • 3+ years of experience working as an LVN/LPN. • 2+ years of care management, utilization review, or discharge planning experience. • Experience in an HMO or Managed Care setting. • Basic knowledge of requirements for Medicare, Medi-Cal, and Commercial lines of business. Benefits • Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution