LPN / LVN Case Manager for Equiliem
3 days ago
Equiliem is seeking a skilled LPN / LVN to fill a challenging Case Management position. As a key member of our team, you will be responsible for reviewing and processing requests for medical services from health professionals and clinical facilities.
This dynamic role requires strong problem-solving skills, excellent communication abilities, and the ability to work in a fast-paced environment. You will utilize CalOptima Health's medical criteria, policies, and procedures to authorize referral requests, ensuring accurate and efficient decision-making.
Your responsibilities will include:
• Reviewing requests for medical appropriateness
• Verifying and processing specialty referrals, diagnostic testing, outpatient procedures, home health care services, and durable medical equipment and supplies
• Screening requests for the Medical Director's review and following up with requesters on decisions
• Completing required documentation for data entry into the utilization management system
To excel in this role, you should possess:
• A current, unrestricted Licensed Vocational Nurse (LVN) license to practice in California
• 3 years of nursing experience, including 1 year as a nurse reviewer
• 1 year of utilization management/prior authorization review experience
• Strong organizational and time management skills, with the ability to work independently and collaboratively as part of a team
• Excellent communication and problem-solving skills, with the ability to adapt to changing priorities and deadlines
We offer a competitive salary range of $37-55 per hour, depending on experience. This position is ideal for individuals who thrive in dynamic environments and are passionate about delivering exceptional patient care.
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