Utilization Review Nurse - LVN

Role Overview:

• Every pre-certification and inpatient stay is a moment where your clinical review decides what happens next for a real person's care.
• Your accuracy and pace keep the entire utilization review process trustworthy and efficient.

Key Responsibilities:

• Assess outpatient, ancillary, and inpatient pre-certification requests including mental health and rehab stays.
• Escalate denial authorizations to the Medical Director and refer out-of-guideline requests to senior consultants.
• Document every review in Eldorado/Episodes with strict confidentiality and evidence-based criteria.

What You Bring:

• Current LVN license in the US or a US territory with 1+ years of clinical experience.
• Working knowledge of ICD-10, CPT, HCPCS coding and MCG guidelines.
• Proficiency with Microsoft Word, Excel, PowerPoint, and Outlook.

Benefits:

• Competitive base salary and comprehensive medical/dental effective day one.
• Paid Time Off, mental health support, retirement planning, and financial protection.
• Professional development with learning budgets and clear career progression.