Salary: $30.00 – $40.00 per hour
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What They’re Looking For
Candidates must hold an active and unrestricted LVN license in Texas and possess at least two years of experience in a health plan, IPA, or MSO setting. Proficiency in Microsoft Office applications and strong interpersonal skills are required for this role.
Skills to Bring
Utilization Review, Prior Authorization, Retrospective Review, Inpatient Admissions, Outpatient Procedures, Durable Medical Equipment, Microsoft Word, Microsoft Excel, Microsoft Outlook, Health Plan Operations, IPA Experience, MSO Experience, Interpersonal Skills, Regulatory Compliance, Accreditation Standards
UM Review Nurse – Texas
Department: HS – UM
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Brenda Kernell
Compensation: $30 – $40 / year
Description
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
- Complete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment
- Refer cases to Medical Directors as needed/appropriate
- Maintain knowledge of state and federal regulations and accreditation standards
- Comply with internal policies and procedures
- Perform any other job duties as requested
Qualifications
- Active and unrestricted LVN license in Texas. Compact license preferred.
- Experience with Microsoft applications such as Word, Excel, and Outlook
- Two (2) years of health plan, IPA or MSO experience
- Strong interpersonal skills
- Ability to collaborate with co-workers, senior leadership, and other management
- Experience educating and training staff
Environmental Job Requirements and Working Conditions
- This is a fully remote position. Nurses must be licensed in the state of Texas.
- Typical business hours are Monday – Friday from 8:30 AM to 5 PM, however, this position requires open availability between 8 AM – 8 PM PST, M-Su. Your schedule will be compromised of 5 shifts per week. Nurses rotate weekend and holiday coverage. Overtime is required in this position.
- The position will operate in PST during the 3 month probationary period. After successful completion of probationary period, position can transition to CST.
- The target pay range for this role is $30.00 – $40.00 per hour. This salary range represents our national target range for this role.