California Licensed Medical Management Specialist

Job Summary

A company is looking for a Medical Management Specialist, LVN.

Key Responsibilities

• Ensure timely and appropriate inpatient and outpatient care for members, adhering to Medical Management policies
• Manage complex medical cases through assessment, planning, and coordination of care
• Facilitate safe discharges from inpatient settings and address urgent quality or access to care issues

Required Qualifications

• Graduation from an accredited school of Licensed Vocational Nursing or equivalent clinical experience
• Current and active California Licensed Vocational Nurse required
• 3+ years of experience in medical-surgical nursing and Utilization Management/Prior Authorization
• Knowledge of California managed care industry and Federal/State healthcare regulations
• Proficient in Microsoft Office applications