3 yrs required
Orange, CA, United States
Case Management, Healthcare, Nursing
Jan 08, 2022
Medical Case Manager (LVN) (Pre-Authorization Nurse Reviewer)
Department(s): Utilization Management, Prior Authorization (PA)
Reports to: Supervisor, Utilization Management
FLSA status: Non-Exempt
Salary Grade: K - $33.6538 - $47.1154 ($70,000 - $98,000)
This position is responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities, and ancillary providers. The incumbent will be responsible for prior authorization and referral related processes that includes on-line responsibilities as well as selected off-line tasks. Utilizes CalOptima's medical criteria, policies, and procedures to authorize referral requests from medical professionals, clinical facilities, and ancillary providers. This position directly interacts with provider callers and serves as a resource for their needs.
Knowledge & Abilities:
Experience & Education:
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.
Job Location: Orange, California
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/3325
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