Temporary - Concurrent Nurse Reviewer; LVN Medical Case Manager; LVN Job Orange area,California USA,Nursing

Position: Temporary - Concurrent Nurse Reviewer (LVN) Medical Case Manager (LVN)

Title:
Temporary - Concurrent Nurse Reviewer (LVN) Medical Case Manager (LVN)
Location:
Orange, CA 92868
Duration: 6 months
Pay Range: USD 45-USD 50/hr

Description
:

The client is seeking a highly motivated and experienced Temporary - Concurrent Nurse Reviewer (LVN) (Medical Case Manager (LVN)) to join the team. The Medical Case Manager (LVN) (Concurrent Review) will be responsible for providing case management intervention on behalf of members with short-term, stable, and predictable courses of illness. The incumbent will evaluate the medical appropriateness, quality, and cost-effectiveness of proposed hospital/medical/surgical services according to established criteria.

Responsibilities
:

Program Support - Participate in a mission-driven culture emphasizing high-quality performance, with a focus on customer service, dignity, and accountability.

Assist the team in executing department responsibilities and collaborate to support departmental goals and priorities.

Review requests for medical appropriateness.

Verify and process specialty referrals, diagnostic tests, outpatient procedures, home health care services, and durable medical equipment and supplies via telephone or fax using established clinical protocols to determine medical necessity.

Screen requests for Medical Director review, gather relevant medical information before submission, communicate decisions, and document follow-ups in the utilization management system.

Complete required documentation for data entry during calls or faxes, including authorization updates.

Review ICD-10, CPT-4, and HCPCS codes for accuracy and coverage relevance.

Coordinate with health networks and/or the client’s Customer Service regarding network enrollments.

Identify and report complaints to the supervisor via call tracking or verbal communication in urgent cases.

Refer cases of possible over/under utilization to the Medical Director for proper reporting.

Maintain productivity and quality standards continually.

Perform other duties and projects as assigned.

Minimum Qualifications
:

High School diploma or equivalent required.
At least 3 years of nursing experience, including 1 year as a nurse reviewer.
Equivalent education and experience may be considered.

Preferred Qualifications
:

1 year of inpatient concurrent review experience.

Required Licensure / Certifications
:

Current, unrestricted Licensed Vocational Nurse (LVN) license in California required.

Why Choose Cogent? Cogent Infotech is a leader in technology consulting, recognized globally for its award-winning services. Based in Pittsburgh, PA, we specialize in digital transformation, leveraging Cloud Computing, Cybersecurity, Data Analytics, and AI. Our mission is to deliver innovative workforce solutions to complex business challenges.

As an ISO-certified firm and CMMI Level 3 appraised, we collaborate with over 70 Fortune 500 companies and 150+ federal and state agencies, providing cutting-edge technology solutions. Cogent is an equal opportunity employer, committed to diversity and inclusion, and does not discriminate based on race, color, religion, national origin, age, sex, pregnancy, genetic information, sexual orientation, gender identity, military status, citizenship, or other protected classes.

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