Medical Case Manager (LVN) Pre-Auth Nurse
The Judge Group Inc.

Orange, California

Posted in IT


This job has expired.

Job Info


Location: Orange, CA
Description: Our client is currently seeking a Medical Case Manager (LVN) Pre-Auth Nurse

This job will have the following responsibilities:Reviews requests for medical appropriateness. •Verifies and processes specialty referrals, diagnostic testing, outpatient procedures, home health care services and durable medical equipment and supplies via telephone or fax by using established clinical protocols to determine medical necessity. •Screen requests for the Medical Director review, gathers pertinent medical information prior to submission to the Medical Director; follows up with the requester by communicating the Medical Director's decision; documents follow-up in the utilization management system. •Completes required documentation for data entry into the utilization management system at the time of the telephone call of fax to include any authorization updates. •Reviews ICD-10, CPT-4 and HCPCS codes for accuracy and existence of coverage specific to the line of business. •Contacts the Health Networks and/or CalOptima Customer Service regarding health network enrollments. •Identifies and reports any complaints to immediate supervisor utilizing the call tracking system, or through verbal communication if the issue is of urgent nature. •Refers cases of possible over/under utilization to the Medical Director for proper reporting. •Meets productivity and quality of work standards on an ongoing basis. •Assists Manager with identifying areas of staff training needs and maintains current data resources. •Other projects and duties as assigned.
please email me your resume for consideration asap to trutkoske@judge.com


Make it a great day!

Tiffany Rutkoske, National Healthcare Recruiter, The Judge Group

16795 Von Karman Avenue Suite 200

Irvine, CA. 92606

Office/ Fax : (949)527-4557 ext. 2834 | Text: (484) 585-4372

trutkoske@judge.com|judge.com|linkedin.com/in/tiffany-rutkoske-a2330b7a

Click to learn more about Judge's Technology, Talent & Learning Solutions

customized clinical workforce solutions

Contact: trutkoske@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.

More IT jobs


The Baer Group
San Francisco, California
Posted about 3 hours ago

The Baer Group
San Jose, California
Posted about 3 hours ago

The Baer Group
Atlanta, Georgia
Posted about 3 hours ago

Get Hired Faster

Subscribe to job alerts and upload your resume!

*By registering with our site, you agree to our
Terms and Privacy Policy.