Utilization Management Licensed Vocational Nurse

2 weeks ago


Irvine, California, United States Optum Full time

Join Optum, a premier organization in the healthcare sector dedicated to transforming health care with a strong focus on health equity, affordability, quality, and convenience. Our mission is to assist millions of patients in leading healthier lives while enhancing the overall health system for everyone. If you are driven by a desire to positively influence health care, this role may be the perfect fit for you.

Position Overview:

  • Accountable for maintaining the integrity of adverse determination processes
  • Ensuring precision in clinical decision-making
  • Drafting denial letters in accordance with regulatory standards

Key Responsibilities:

  • Exhibit a strong commitment to customer service
  • Execute all responsibilities of the UM nurse reviewer
  • Prepare denial notifications with clear justifications
  • Supply pertinent clinical data for informed decision-making
  • Assess out-of-network and tertiary denials
  • Guarantee adherence to established guidelines

Essential Qualifications:

  • Completion of an accredited Licensed Vocational Nurse program
  • Valid LVN license in California
  • Minimum of 1 year of experience as a UM nurse reviewer
  • At least 1 year of recent clinical experience as an LVN/LPN

Preferred Qualifications:

  • Bachelor's degree in Nursing
  • 3+ years of experience in managed care utilization
  • 1+ years of experience in CDU nursing

Knowledge, Skills, and Abilities:

  • Proficient in Microsoft Office Suite and utilization management software
  • Capable of making sound, independent judgments
  • Familiarity with managed care regulations and guidelines
  • Strong communication skills

Become a part of our mission to promote healthier living and enhance the health system for all. We value diversity and are dedicated to providing equitable care that addresses health disparities and improves health outcomes.



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