Job Description
Description:
JOB SUMMARY
The Denial Review LVN supports the Utilization Management and Denial Compliance functions by assisting with the review, auditing, and correction of denial documentation to ensure compliance with applicable regulatory, contractual, and accreditation standards. Working within the scope of an LVN license, this role focuses on denial language accuracy, timeliness, and completeness, while providing education and support to medical group staff under established policies and procedures.
Requirements:
MINIMUM & PREFERRED QUALIFICATIONS
Education/Training
Minimum: High school diploma or equivalent required. Graduate of an accredited Licensed Vocational Nursing program.
Preferred: Training or coursework related to utilization management, managed care, or healthcare compliance.
Experience
Minimum: 1+ years of LVN experience in a healthcare setting.
Preferred: Experience in utilization review, denial management, managed care, or healthcare compliance
Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.
Certification(s)
Current, active, unrestricted California LVN license required.
Skills, Knowledge & Abilities
Knowledge of basic utilization management and denial processes
Familiarity with managed care and regulatory environments (e.g. NCQA, DMHC, CMS)
Ability to interpret guidelines and apply standardized criteria with direction
Strong written and verbal communication skills
Attention to detail and ability to audit documentation for compliance
Ability to manage multiple tasks and meet deadlines
Proficiency with electronic health records and standard office software
Professional, collaborative, and adaptable work style
PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS
The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. This position involves primarily sedentary office work with prolonged periods of sitting and computer use, along with occasional standing, walking, and minimal lifting (generally under 25 pounds). The role is performed in a standard office environment with no routine patient lifting or exposure to hazardous conditions and may require occasional travel to meetings or office locations as needed.
PAY RANGE
$35.00 - $40.00 / hourly
