Case Manager LVN (Prior Auth)
The Judge Group Inc.

Location: Orange, CA
Salary: $33.00 USD Hourly - $40.00 USD Hourly
Description: The Medical Case Manager (LVN) plays a crucial role in ensuring the efficient and effective delivery of medical services. As a key member of our team, you will review and process requests for authorization and notification of medical services from health professionals, clinical facilities, and ancillary providers.
Position Responsibilities:

• Mission-Driven Culture: Participate in a mission-driven culture that emphasizes high-quality performance, customer service, consistency, dignity, and accountability.
• Collaboration: Assist the team in carrying out department responsibilities and collaborate with colleagues to support short- and long-term goals.
• Medical Appropriateness: Review requests for medical appropriateness, ensuring alignment with established criteria.
• Referral Processing: Verify and process specialty referrals, diagnostic testing, outpatient procedures, home health care services, and durable medical equipment and supplies via telephone or fax.
• Medical Director Review: Screen requests for Medical Director review, gather pertinent medical information, and communicate decisions to requesters.
• Documentation: Complete required documentation for data entry into the utilization management system, including authorization updates.
• Code Accuracy: Review International Classification of Diseases (ICD-10), Current Procedural Terminology (CPT-4), and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and coverage.

Qualifications:

• Licensed Vocational Nurse (LVN) Certification
• Experience in Medical Case Management or Utilization Review
• Strong Communication Skills
• Attention to Detail and Accuracy

How to Apply:

Interested candidates should submit their resume and a cover letter detailing their relevant experience to Jacob at jmaybrier@judge.com

Thank You,

Jacob

Contact: jmaybrier@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

This job has expired.