Adecco Healthcare & Life Sciences is hiring a Remote/ Work From Home Utilization Management LPN ! Please read below and apply with an updated resume for consideration:

Type: Two - month contract, opportunity for extension or fulltime offer

Schedule: Monday through Friday, 8am to 5pm

Pay: $32.85 - $34.85 per hour

Responsibilities of the Utilization Management LPN:

· Acting within the scope of their license, ensures that prior authorization requests are appropriately reviewed and completed in a timely manner to meet contractual and regulatory requirements.

· Coordinate and follow established prior authorization review process for outpatient and inpatient service requests.

· Collaborates as directed with the Case Management Department or other departments as needed.

· Accurate, thorough, and efficient review of prior authorization requests.

· Timely review of prior authorization requests to include acute hospital pre-admission, surgical and diagnostic procedures, therapies, durable medical equipment, and home health care.

· Conducts medical determinations based on nationally recognized and evidence based guidelines, and in accordance with the policies and procedures approved by the physician group Medical Directors and UM Committees.

· Audits and evaluates patient medical records when determining benefit coverage and medical necessity, including appropriateness and level of care.

· Reviews prior authorization requests in coordination with group Medical Directors as required.

· Assists UM Coordinators and other clerical staff with issues and concerns that require clinical interpretation or definition including assisting patients with interpretation of criteria used in determinations as requested.

· Assists in processing denial and extension letters using appropriate language, health literacy level, criteria, and policies.

Qualifications for the Utilization Management LPN:

· Active LPN license in the state of California

· Graduate of an accredited school of nursing required.

· Bachelors Degree in nursing or healthcare related field or current equivalent related work experience.

· One year clinical experience in an acute or ambulatory patient care setting including one year in a managed care environment such as a medical group, independent physician association, or health plan is required.

· Knowledge of Medicare, DMHC, NCQA, and MCG Guidelines

· Proficient in Microsoft Office suites

Why work for Adecco?

· Weekly Pay

· 401(k) Plan

· Skills Training

· Excellent medical, dental, and vision benefits

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.

IMPORTANT: This Utilization Management LPN is being recruited for by Adecco’s Healthcare & Life Sciences division, not your local Adecco Branch Office.

For opportunities www.adeccousa.com/industries/medical-and-science

Equal Opportunity Employer/Veterans/Disabled. To read our Candidate Privacy Information Statement, which explains how we will use your information, please visit http://www.adeccousa.com/candidate-privacy/.

The Company will consider qualified applicants with arrest and conviction record

Pay Details: $32.85 to $34.85 per hour

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adecco.com/en-us/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.