We’re Hiring: UM Prior Authorization Nurse (LVN – CA Licensed)

Location: Chatsworth California 91311

Company: Medix

Employment Type: Full-Time

Training: Will be fully onsite for 4-6 weeks and then fully remote after! Must be able to train onsite in Chatsworth, California 91311.

Are you a detail-oriented nurse with strong clinical judgment and a passion for ensuring patients receive the care they need — when they need it? Medix is seeking a dedicated and highly skilled Utilization Management (UM) Prior Authorization Nurse to join our team.

In this role, you’ll use your clinical expertise and independent judgment to review prior authorization referrals, determine medical necessity, and support the delivery of high-quality, cost-effective care. You’ll collaborate closely with clinical leaders and leverage a variety of health plan and state guidelines to guide your decision-making.

Key Responsibilities:

• Independently review 55–60 new prior authorization referrals per day.
• Assess records for clinical appropriateness using guidelines (Health Plan, Medi-Cal, Medicare, Milliman, Apollo).
• Issue approvals for services that meet criteria.
• Draft clinical summaries for Medical Director review when a denial is considered.
• Monitor and process deferred referrals as new records are received.
• Attend monthly team meetings and stay aligned with evolving protocols.
• Participate in optional weekend bonus work (with set case-based incentives).

Qualifications:

• Current CA LVN license required.
• Minimum 2 years of experience in prior authorization, utilization review, or managed care.
• Strong working knowledge of medical terminology, clinical guidelines, and insurance plans.

What Sets You Apart:

• Detail-oriented and efficient — balancing speed and accuracy.
• Comfortable working with daily case volume expectations in a fast-paced, deadline-driven environment.
• Dependable, accountable, and collaborative with a commitment to excellence.
• Able to professionally represent the organization through written communication and clinical documentation.

Additional Details:

• Daily assignments are emailed by 8:30 AM.
• Flexible start times available.
• Standard 8-hour workday (with breaks/lunch built-in).
• Nurses may opt in for weekend bonus work (varied referral volumes and set incentive payments).
• Denial decisions are made by the Medical Director; nurses provide the supporting clinical rationale only.

✅ Why Join?

• Be part of a smart, supportive team with strong clinical leadership.
• Make a real impact in healthcare decision-making.
• Enjoy flexibility, structure, and growth potential.
• Bonus opportunities available through weekend programs.

Ready to use your clinical knowledge in a dynamic utilization management setting?

Apply now or reach out to our team to learn more!

#NurseJobs #UtilizationManagement #PriorAuthorization #LVN #HealthcareCareers #ManagedCare #RemoteNursing #ClinicalReview #HiringNow