California Licensed Utilization Nurse

To promote quality and cost-effective outcomes, the full-time California Licensed Utilization Nurse will manage prior authorization requests, collaborate with healthcare providers and patients, and ensure compliance with regulatory requirements while working remotely. Key responsibilities Evaluate and process prior authorization requests based on clinical guidelines and medical necessity Act as a liaison between healthcare providers, patients, and health plans to facilitate the authorization process Accurately document all authorization activities and maintain compliance with federal, state, and health plan regulations Required qualifications Active, unrestricted California nursing license as a Licensed Vocational/Practical Nurse (LVN/LPN) Minimum of 2-3 years of clinical nursing experience, including at least 1 year in utilization review or case management Experience in a managed care setting with medical necessity reviews is strongly preferred Preferred certifications include Certified Professional in Utilization Review (CPUR) or Certified Case Manager (CCM) Proficiency in medical terminology and experience with EMR systems and prior authorization platforms