Denial Review LVN at LSMA Management Inc

San Bernardino, California, United States -

Full Time

Start Date

Immediate

Expiry Date

03 Jul, 26

Salary

40.0

Posted On

04 Apr, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization management, Denial management, Healthcare compliance, Managed care, Regulatory environments, NCQA, DMHC, CMS, Documentation auditing, Written communication, Verbal communication, Attention to detail, Electronic health records, Office software, Time management

Industry

Health and Human Services

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: 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 State LVN License 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.

Responsibilities

The Denial Review LVN supports utilization management and denial compliance by auditing and correcting denial documentation. This role ensures accuracy and completeness while providing education to medical group staff.