Lvn Case Manager - Utilization Mgmt - Corporate Offices/telecommuter - Days - Ft
Sharp Chula Vista Medical Center
San Diego, CA, United States
$34.170 - $49.370 ph
On-site
Perform clinical/medical necessity reviews
Authorize medical services
Identify benefit coverage
The CMI performs clinical/medical necessity reviews and authorizes medical services that meet medical criteria for outpatient healthcare services
Job Summary
The CMI performs clinical/medical necessity reviews and authorizes medical services that meet medical criteria for outpatient healthcare services.
Reviews include pre-certification requests, outpatient procedures, elective inpatient admissions, home health services, and complex durable medical equipment.
The role requires effective communication, time management, and the ability to apply approved criteria like MCG to medical information.
Matching Summary
The CMI performs clinical/medical necessity reviews and authorizes medical services that meet medical criteria for outpatient healthcare services.
Salary
$34.170 - $49.370
Skills & Requirements
Must-have
Perform clinical/medical necessity reviews
Authorize medical services
Identify benefit coverage
Apply approved criteria to medical information
Communicate decisions effectively
Nice-to-have
Experience in managed care
Serve as a resource and mentor
Participate in quality improvement activities
Key Requirements
2 Years Experience in a medical setting
California Licensed Vocational Nurse (LVN)
Proficient in typing and computer data entry (45 wpm)
Proficient in use of ICD-10, CPT and HCPC coding systems