Temp LVN/LPN – Utilization Review Nurse

This is a fully remote position, open to applicants in California.

📋 Description

• Assess medical records to establish the medical necessity of requests for healthcare services.

• Confirm diagnoses and the associated care algorithms.

• Analyze treatment requests for over-utilization that do not align with evidence-based guidelines.

• Liaise with the claims examiner, healthcare providers, and any relevant auxiliary personnel regarding Utilization Review determinations.

• Compile medical records and all relevant information for the Physician Advisor.

• Recognize the need for medical case management and provide recommendations for referral through the supervisor.

⛳️ Requirements

• At least 3 years of clinical experience.

• Experience in California Worker’s Compensation and Managed Care/Utilization Review is preferred.

• Must be knowledgeable about California Worker’s Compensation regulations and medical terminology.

• Completion of IEA CA10 is mandatory within one year of employment.

🏝️ Benefits

• Comprehensive medical, dental, and vision benefits.

• Company contributions to Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).

• Employer-paid life and disability insurance.

• 401(k) plan with company matching.

• Paid time off (PTO) along with company-paid holidays.

• Opportunities for learning and development that promote genuine career advancement.

• Employee assistance resources and a nurturing culture that prioritizes balance and well-being.