Job Summary

• Performs utilization review of cases to determine if the request meets medical necessity criteria in accordance with medical policies.
• Engages in phone conversations with ordering providers, members, internal staff, primary care physicians (PCPs), and rendering providers as necessary to facilitate the clinical review process.
• Our benefits package includes medical, dental, and vision insurance, paid time off, holidays, sick leave, and a 401(k) with company match.

Matching Summary

Salary

Base: $65,000 [LVN/LPN], $75,000 [RN] annually; Bonus/Equity: Performance-based bonuses, incentive pay, or commissions may be eligible; Benefits: Medical, dental, and vision insurance, PTO, holidays, sick leave, 401(k) with company match, Life and AD&D Insurance, EAP

Skills & Requirements

Key Requirements

• RN, LPN/LVN graduate from accredited school
• Current, active unrestricted RN, LPN/LVN license
• Minimum two years utilization review experience
• Proficient in Microsoft Office
• Working knowledge of NCD and LCD

Work Rights