Position Title: UM Licensed Vocational Nurse

Location: Montebello, CA

Schedule: Full Time /  Nights and weekends (Night schedule 2pm-11pm, Weekend 6am-2:30pm)

Pay: $33-$46  - Depending on Experience

Job Type: Temporary Assignment

Job Summary:The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization requests from all lines of business using respective national/state, health plan, nationally recognized guidelines. Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency with coverage guidelines. The UM Nurse determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.

Required Skills and Abilities:

1. Uses computer and computer system (including hardware and software) to perform necessary functions.

2. Communicates effectively in writing as for the needs of the audience.

3. Demonstrates excellent interpersonal skills.

4. Maintains dedicated attention to detail.

5. Analyzes and interprets reports and data for management purposes.

6. Demonstrate knowledge of DOFRs and delegation agreements

7. Adheres to the Altamed Heath services HIPAA Compliance Plan and the Privacy Standards Confidentiality Agreement.

8. Knowledge of pre-authorizations and reimbursement regulations pertaining to Medicare, Medi-Cal, Commercial, CCS and other government programs

Specifications / Experience:

1. Current valid License as a Licensed Vocational Nurse.

2. Minimum of 2 years of managed care experience

3. Demonstrated ability to work with automated systems, including electronic medical records and MS Office products such as Word, Excel and Outlook.

4. Excellent customer service; ability to be an effective communicator

5. Knowledge of federal, state and other applicable standards for clinical practice for assigned area(s) of responsibility.

6. Ability to work collaboratively with diverse individuals and situations, including strong problem solving and conflict resolution skills.

We will consider all employment qualified Applicants with Criminal Histories in a manner consistent with the requirements of FCIHO