California Licensed Utilization Management Nurse

A company is looking for a Utilization Management Nurse - LVN (Work from Home).

Key Responsibilities

Perform medical necessity reviews for assigned members

Collaborate with the Medical Director on adverse determination notices

Ensure timely discharge planning and communication with care teams

Required Qualifications, Training, and Education

Associate's degree in Nursing, preferred

Minimum 2 years of experience in medical management clinical functions

Working knowledge of MCG, InterQual, and NCQA standards

Active License as a Licensed Vocational Nurse (LVN) in California

Certification in Managed Care Nursing (CMCN) preferred