LVN – Utilization Review – Remote within San Diego County

About the position

The Licensed Vocational Nurse (LVN) in Utilization Review at Scripps Health is responsible for reviewing and managing assigned cases for members enrolled in Scripps Clinic Health Plan Services. This full-time remote position requires the determination of medical necessity, benefit determination, and eligibility, while also ensuring compliance with regulatory agency time frames. The role emphasizes teamwork and commitment to providing excellent care to patients.

Responsibilities
• Review and manage assigned cases for members enrolled in Scripps Clinic Health Plan Services.
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• Determine medical necessity for services requested.
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• Assess benefit determination and eligibility for services.
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• Manage multiple tasks within regulatory agency time frames.

Requirements
• Current California LVN license.
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• Three years of recent clinical experience in various settings.
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• Managed Care experience is strongly recommended.
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• Graduate of an accredited LVN or RN Program.

Nice-to-haves
• Previous experience in Utilization Management (UM), Quality Improvement (QI), Discharge Planning, or Case Management.

Benefits
• Comprehensive health and wellness benefits.
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• Career development opportunities.
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• Retirement options.