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Prior-Authorization Utilization Review Nurse
- Posted: September 18, 2023
- Salary:US$33.65 - US$54.94 per hour
- Location:Orange
- Job type: Contract
- Discipline:Care Management
- Reference:212180_1695057287
- Work Location:Hybrid
Job description
Position: LVN Case Manager
Salary: - $33.65 -$44.30- $54.94
Duration: up to 6 months
Location: Orange, CA
Monday-Friday 8am-4:30pm
This position has the potential to be HYBRID
Job Summary
Medix is looking for a Medical Case Manager at a Health Plan in Orange County. The Medical Case Manager facilitates communication and coordination among all participants of the health care team as well as to the member and/or caregiver to ensure the services are provided to promote quality cost-effective outcomes.
This individual will be responsible for performing comprehensive, disease specific clinical assessment of the member.
They will develop a care plan specific to this member, and provide consistent follow up to help the member reach their goals.
Additionally, interfacing with clinical providers, SNF's, ALF's and other community agencies will be necessary.
Requirements:
LVN license in the state of California
3 plus years of clinical experience, minimum, 1+ year as a Clinical Review Nurse
1+ years of CM/UM/Prior Authorization experience (in a health plan, or IPA/MSO) preferred
Experience working in a criteria tool such as MCG or Interqual required
Desired Skills and Experience
Current CPT-4, ICD-10, and Healthcare Common Procedure Coding System
Medical Terminology
Medi-Cal and Medicare benefits and Regulations
Detail Oriented
#MedixWest