Remote, LVN Utilization Management Nurse

Pay: $38 – $46 per hour
Assignment Type: Temporary through the end of 2026
Location: Remote with occasional on-site meetings in Montebello, CA

Position Overview

A managed care organization is seeking a Licensed Vocational Nurse (LVN) with Utilization Management Department experience to support authorization and medical necessity reviews across multiple lines of business.

The LVN UM Nurse will review authorization requests, evaluate treatment plans, and determine the medical appropriateness of inpatient and outpatient services using nationally recognized guidelines and health plan criteria.

Schedule

Day Shift: MN-F 9:00 AM - 6:00 PM

REQUIREMENTS, MUST HAVES!!!

Current and active Licensed Vocational Nurse (LVN) license
Minimum 3 years of managed care experience (IPA/HMO)
2 years minimum of current experience with processing prior authorizations, referrals (all lines of business), and utilization reviews is required
Proficiency with electronic medical records and Microsoft Office (Word, Excel, Outlook)
BLS Certification is required (AHA or RC)
Strong communication, customer service, and problem-solving skills
Knowledge of Medicare, Medi-Cal, Commercial, and government programs
Will need to use a personal laptop or desktop computer

Job Overview

Experience using InterQual, Milliman, or other utilization review criteria.Key Responsibilities
Review and process authorization and referral requests within required turnaround times.
Evaluate hospitalization, home health, inpatient, and outpatient services for medical necessity and efficiency.
Apply evidence-based guidelines such as InterQual, Milliman, CMS, and health plan criteria.
Verify member eligibility and benefits upon receipt of authorization requests.
Enter and maintain accurate documentation in the medical management system.
Communicate authorization decisions to providers and members in a timely manner.
Collaborate with medical directors, hospital partners, and care teams to support appropriate care planning.
Assist with LOA (Letter of Agreement) processing for non-contracted providers or facilities.
Monitor ongoing services and recommend care plan adjustments when appropriate.

Pay: $38.00 - $46.00 per hour

Benefits:

Dental insurance
Health insurance
Life insurance
Vision insurance

Application Question(s):

Do you have experience using InterQual, Milliman, or other utilization review criteria?
Are you comfortable commuting to Montebello, CA for occasional meetings and training?

Experience:

Prior authorization: 2 years (Required)
Managed care: 3 years (Required)

License/Certification:

BLS Certification (Required)

Work Location: Hybrid remote in Montebello, CA 90640

Medica Talent Group, Inc.

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