UM Nurse, LVN 25-00418

Under the general direction of the Utilization Management Clinical Manager and Supervisor, and within the LVN scope of practice, the incumbent is responsible for working directly with Providers, contracted entities, and vendors to ensure coordinated, continuous cost-effective quality healthcare for IEHP Members.

• Two (2) or more years of utilization management experience in a health care delivery setting
• Experience in an HMO or experience in a Managed Care setting preferred
• High School Diploma or GED required
• Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required

• Knowledge of Title 22, Title 10, DMHC, DHCS, and CMS regulatory requirements. ICD-9/10 and CPT coding
• Knowledge of capitated managed care environment helpful
• MediCal, Medicare and other state/federal Program & Regulations
• Proficiency in Excel preferred
• Microcomputer skills, proficiency in Windows applications preferred
• Excellent communication and interpersonal skills
• Strong organizational skills.
• Professional demeanor