Remote LVN Claims Review Nurse – Medical Necessity

Inland Empire Health Plan in California seeks an LVN-validated Claims Review Nurse to audit medical necessity across inpatient and outpatient claims and support the UM/Claims interface. You will analyze records, determine authorization needs, and collaborate with physicians and staff to improve denial management and care pathways.

The role requires an active California LVN license, at least one year of relevant experience, and familiarity with Medi-Cal/Medicare concepts, with a focus on accuracy

For the Remote LVN Claims Review Nurse – Medical Necessity position at Inland Empire Health Plan, we are reviewing applications now.

This Full Time role is for the Remote LVN Claims Review Nurse – Medical Necessity role at Inland Empire Health Plan.

We are seeking a motivated Remote LVN Claims Review Nurse – Medical Necessity to join Inland Empire Health Plan in Rancho Cucamonga, CA, United States.