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Prior-Authorization Utilization Review Nurse

Posted: September 18, 2023
Salary:US$33.65 - US$54.94 per hour
Job type: Contract
Discipline:Care Management
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.


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