Utilization Management LVN
1 month ago
Job Description
Insight Global is looking for a Utilization Management Delegation and Compliance LVN for one of their largest healthcare clients located in southern California. This position is 100% remote but they must sit 50 miles from Irvine to pick up equipment.
Primary Responsibilities:
• In collaboration with the Manager of Delegation Oversight, manages delegation oversight and regulatory audits.
• Leverages knowledge of clinical services regulatory and delegation requirements to represent Optum Clinical Services appropriately while managing delegation oversight audits
• Serves as a liaison between Health Plan delegated entities and Clinical Services Operational teams (Utilization Management and Case Management)
• Serves as a liaison between Delegation Oversight and cross-functional areas/departments across the organization
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Must Haves:
- * Graduation from an accredited Licensed Vocational/Practical Nurse program
- * Current LVN/LPN license in State of Residence
- * 3+ years of clinical experience working as an LVN/LPN
- * 2+ years of care management, utilization review (prior authorization) or discharge planning experience
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