Utilization Mgmt LPN/24/NUR130
The Judge Group Inc.

Miami, Florida

This job has expired.

Location: REMOTE
Salary: $20.00 USD Hourly - $32.00 USD Hourly
Are you a LVN/LPN looking for a new remote role? Well, look no further! Our client is in search of a Remote LVN/LPN! Interested? Send your resume to me at: Mthum02@judge.com or give me a call directly at: (484) 639-7074

Scope of Role:

  • Title: Remote Utilization LPN/LVN
  • Location: Remote | Must be licensed in CA
  • Type: Contract | ongoing
  • Hours: 8am - 5pm PST


  • Reviews all requests for specialty care, elective surgeries, treatment plans and diagnostic studies in accordance with commercial and senior health plan and CMS timelines.
  • Utilizes health plan, CMS, Milliman and Hayes as sources for documenting appropriateness and standard of care. Seeks consultation from IPA Medical Director when request for services does not meet health plan, CMS, Milliman or Hayes recommendations.
  • Seeks to obtain a complete data set about the treatment plan and patient progress. This can include calling the attending physician, discussing therapy with the physical therapist and/or consultation with the primary nurse.
  • Tracks and trends over-utilization of procedures, resources and benefits by provider.
  • Documents access to care issues/unable to provide services in UM information system if capitated provider is unable to provide requested service.


  • Must be licensed LVN/LPN
  • At least one years of Exp.
  • Must be licensed in CA
  • Exp. with Utilization management

Contact: mthum02@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.

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