APN Consulting Inc.
Website:
apnconsultinginc.com
Job details:
APN is exploring opportunities for experienced Utilization Management (UM) Nurses who are currently based in India and Philippines; hold an active and unrestricted California LVN license.
This is a remote, full-time opportunity supporting a U.S.-based healthcare organization. The role involves reviewing clinical cases to determine medical necessity using established clinical guidelines and criteria.
Key Responsibilities- Perform prospective and pre-service medical necessity reviews.
- Review clinical documentation and apply appropriate criteria, including MCG, Medicare, Medicaid/Medi-Cal, and health-plan-specific guidelines.
- Support concurrent review of cases and appropriate discharge/transition-of-care processes.
- Collaborate with the client's clinical team and Medical Director on cases requiring additional review.
- Accurately document utilization review findings.
- Meet established quality and productivity expectations.
- Serve as a clinical resource to non-clinical team members when required.
Required Qualifications- Active and unrestricted California Licensed Vocational Nurse (LVN) license - mandatory
- Minimum 2 years of experience in Utilization Management, Utilization Review, or medical necessity review
- Experience applying MCG criteria or similar clinical guidelines
- Good understanding of U.S. healthcare and clinical documentation
- Strong written and verbal English communication skills
- Comfortable working remotely and independently
Work Location & Hours- Location: Remote - India, Philippines
- Schedule: Full-time
- Must be able to work 8:00 AM-5:00 PM Pacific Time
- Some weekend and U.S. holiday coverage may be required
Preferred- Certification in Managed Care Nursing (CMCN)
- Previous experience supporting a U.S. health plan, managed care organization, utilization management operation, or healthcare services organization
- Experience working remotely for a U.S.-based healthcare organization
If you are currently based in India, hold an active California LVN license, and have relevant Utilization Management experience, we would like to hear from you.
Please apply with your resume and details of your California LVN license and relevant UM/Utilization Review experience on purvi@apnconsultinginc.com
We are committed to fostering a diverse, inclusive, and equitable workplace where individuals from all backgrounds feel valued and empowered to contribute their unique perspectives. We strongly encourage applications from candidates of all genders, races, ethnicities, abilities, and experiences to join our team and help us build a culture of belonging.
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