Remote Utilization Review LPN/LVN

Remote Utilization Review LPN/LVN
HealthCare Support is actively seeking a Remote Utilization Review LPN/LVN.
Daily Responsibilities for Remote Utilization Review LPN/LVN:

Concurrent review for inpatient charts using MCG (Milliman Care Guidelines) and Medicare guidelines

Responsible for providing timely referral determination by accurate:

Usage of the Milliman Care Guidelines

Identification of referrals to the medical director for review

Appropriate letter language (i.e. – denials)

Appropriate selection of the in or out of network providers

Proper identification of eligibility and health plan benefits

Work directly with the provider(s) and Medical Director to facilitate quality service to the member and provider

Identifies and refers members to the appropriate healthcare program (e.g. case management, disease management)

11:30 to 8pm PST or 8:30 to 5pm HST (Hawaii) – Remote

Required Qualifications for Remote Utilization Review LPN/LVN:

High School Diploma or GED

Active and unrestricted LVN/LPN license in CA (can sit in another state PST or MST but need to be able to work PST hours)

1+ year of inpatient/concurrent review

Benefits for Remote Utilization Review LPN/LVN:

Immediate enrollment in Health Insurance

Dental Insurance

Life Insurance

Employee Assistance Program (EAP)

Access to Investment Accounts

Career and educational tools within our Ingenovis ACT (Advocacy) Program

Pay Details: $34/hour – $37/hour
Interested in being considered?
If you are interested in applying to this position, please click Apply Now for immediate consideration.
For additional consideration, please email a copy of your resume to with your phone number, the job title and location, and our recruiters will reach out.
Healthcare Support Staffing, LLC. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
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Healthcare Support