LVN, Utilization Management – Remote – 2249754 El Segundo, CA 11/08/2024 Nursing

About the position

The LVN, Utilization Management position is a remote role responsible for coordinating Health Plan Delegation Oversight audits and conducting internal quality reviews for Case Management and Utilization Management. The role involves preparing audit documentation, communicating with auditors, and facilitating compliance audits to ensure adherence to regulatory requirements. This position offers the opportunity to work in a dynamic environment focused on improving health care delivery.

Responsibilities
• Prepares and submits pre-audit documentation as outlined on Health Plan audit tools.
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• Communicates with Health Plan auditors related to audit documents and processes.
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• Collaborates across the organization to gather necessary documentation to meet audit requirements.
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• Facilitates onsite/virtual/desktop compliance audit reviews to ascertain regulatory requirements adherence.
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• Participates in performance improvement activities.
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• Conducts comprehensive internal audits of the end-to-end utilization management process.
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• 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.
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• Current LVN/LPN license.
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• 2+ years of clinical experience working as an LVN/LPN.
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• 1+ years of utilization management experience, especially in Prior Authorization.

Nice-to-haves
• 3+ years of experience working as an LVN/LPN.
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• 2+ years of care management, utilization review, or discharge planning experience.
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• Experience in an HMO or Managed Care setting.
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• Basic knowledge of requirements for Medicare, Medi-Cal, and Commercial lines of business.

Benefits
• Comprehensive benefits package
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• Incentive and recognition programs
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• Equity stock purchase
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• 401k contribution