Utilization Management LVN
Job Title: Remote LVN Case Manager - Utilization Management
Job Description
Join our dynamic Utilization Management team as an LVN Case Manager where you will assess requests against clinical guidelines and effectively communicate decisions to providers and patients. This role involves performing initial reviews and working with various healthcare criteria within outpatient cases.
Responsibilities
ā¢ Conduct initial reviews of outpatient cases, averaging 40 cases per day, with expectations in the high 30s.
ā¢ Ensure compliance with turnaround times and accuracy standards.
ā¢ Coordinate with contracted providers and obtain appropriate contracts as necessary.
ā¢ Identify cases requiring additional case management and coordinate care with relevant departments.
ā¢ Collaborate with internal staff to ensure seamless care coordination.
Essential Skills
ā¢ Utilization review and management experience.
ā¢ Familiarity with Medicare, MediCal, and Milliman Criteria Guidelines.
ā¢ Proficiency in prior authorizations and case management.
ā¢ Knowledge of NCQA standards.
Additional Skills & Qualifications
ā¢ 2+ years of outpatient utilization management experience.
ā¢ Must be knowledgeable in MCG.
ā¢ Experience working with provider offices.
ā¢ Familiarity with MediCal and Medicare regulations.
ā¢ Proficiency in EZ-CAP is a plus.
ā¢ High School Diploma or GED required; Bachelor of Science in Nursing or other clinical advanced degree preferred.
ā¢ 1+ year of managed care experience preferred.
ā¢ 1+ year of inpatient experience preferred.
Work Environment
This position offers a remote work environment with a standard schedule of Monday to Friday, 8am-5pm, including a 1-hour lunch break. Occasional work on holidays and weekends may be required to support team needs.
Pay and Benefits
The pay range for this position is $29.00 - $37.00/hr.
Eligibility requirements apply to some benefits and may depend on your job
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
Available For This Temporary Role May Include The Following
ā¢ Medical, dental & vision
ā¢ Critical Illness, Accident, and Hospital
ā¢ 401(k) Retirement Plan ā Pre-tax and Roth post-tax contributions available
ā¢ Life Insurance (Voluntary Life & AD&D for the employee and dependents)
ā¢ Short and long-term disability
ā¢ Health Spending Account (HSA)
ā¢ Transportation benefits
ā¢ Employee Assistance Program
ā¢ Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Sep 2, 2025.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email [email protected] for other accommodation options.
Apply Now
Apply Now
Job Description
Join our dynamic Utilization Management team as an LVN Case Manager where you will assess requests against clinical guidelines and effectively communicate decisions to providers and patients. This role involves performing initial reviews and working with various healthcare criteria within outpatient cases.
Responsibilities
ā¢ Conduct initial reviews of outpatient cases, averaging 40 cases per day, with expectations in the high 30s.
ā¢ Ensure compliance with turnaround times and accuracy standards.
ā¢ Coordinate with contracted providers and obtain appropriate contracts as necessary.
ā¢ Identify cases requiring additional case management and coordinate care with relevant departments.
ā¢ Collaborate with internal staff to ensure seamless care coordination.
Essential Skills
ā¢ Utilization review and management experience.
ā¢ Familiarity with Medicare, MediCal, and Milliman Criteria Guidelines.
ā¢ Proficiency in prior authorizations and case management.
ā¢ Knowledge of NCQA standards.
Additional Skills & Qualifications
ā¢ 2+ years of outpatient utilization management experience.
ā¢ Must be knowledgeable in MCG.
ā¢ Experience working with provider offices.
ā¢ Familiarity with MediCal and Medicare regulations.
ā¢ Proficiency in EZ-CAP is a plus.
ā¢ High School Diploma or GED required; Bachelor of Science in Nursing or other clinical advanced degree preferred.
ā¢ 1+ year of managed care experience preferred.
ā¢ 1+ year of inpatient experience preferred.
Work Environment
This position offers a remote work environment with a standard schedule of Monday to Friday, 8am-5pm, including a 1-hour lunch break. Occasional work on holidays and weekends may be required to support team needs.
Pay and Benefits
The pay range for this position is $29.00 - $37.00/hr.
Eligibility requirements apply to some benefits and may depend on your job
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
Available For This Temporary Role May Include The Following
ā¢ Medical, dental & vision
ā¢ Critical Illness, Accident, and Hospital
ā¢ 401(k) Retirement Plan ā Pre-tax and Roth post-tax contributions available
ā¢ Life Insurance (Voluntary Life & AD&D for the employee and dependents)
ā¢ Short and long-term disability
ā¢ Health Spending Account (HSA)
ā¢ Transportation benefits
ā¢ Employee Assistance Program
ā¢ Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Sep 2, 2025.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email [email protected] for other accommodation options.
Apply Now
Apply Now