LVN-Hybrid

Hybrid LVN-Inpatient Job Duties

• Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and discharges
• Apply CMS regulations and evidence-based criteria (MCG, InterQual) to evaluate medical necessity
• Collaborate with hospital teams, providers, IPA case managers, and health plan representatives
• Conduct in-person hospital rounds 2–3 days per week, telephonic review and participate in interdisciplinary case reviews
• Escalate complex or ambiguous cases to the Health Medical Director or Physician Reviewer
• Ensure complete, accurate, and compliant documentation in alignment with CMS standards
• Monitor daily inpatient census for Health–managed members across contracted hospitals
• Support discharge planning and identify post-acute needs including SNF, rehab, home health, or DME
• Communicate avoidable days, delays in care, and readmission risks to UM leadership
• Participate in audit readiness, quality improvement projects, and performance reporting
• Educate providers and facilities on Medicare UM criteria and Health documentation standards
• Performs related duties consistent with the scope and intent of the position.
• Adhere to all departmental performance metrics (turnaround times, quality standards, productivity).
• Attend educational sessions and training to stay current with Medicare UM requirements and policies.
• Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
• Participate in interdisciplinary team meetings and represent the UM department effectively

Requirements

• 3+ years of inpatient hospital nursing experience (e.g., med-surg, telemetry, ICU)
• At least 1 year of experience in utilization review, case management, or hospital discharge planning
• Familiarity with CMS inpatient criteria, including the Two-Midnight Rule
• Proficiency in Microsoft Office and electronic medical record (EMR) systems
• Previous experience with IPA, MSO, or delegated managed care environments preferred.
• Working knowledge of EZ-CAP, EZ-Net, InterQual, and MCG preferred.
• Certified Case Manager (CCM), CPUR, or CPHM credential preferred but not required
• Background in concurrent review or inpatient census oversight preferred.
• Strong critical thinking, communication, and clinical documentation skills
• Excellent communication skills, including both oral and written.
• Excellent active listening and critical thinking and analytical skills.
• Ability to solve mid-level problems with minimal supervision.
• Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
• Excellent attention to detail and ability to document information accurately.
• Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
• Must have mid-level skills in Microsoft software (Word, Excel, PowerPoint, Visio) and Access is a plus.
• Must have the ability to quickly learn and use new software tools.

Additional Skills & Qualifications

• CA LVN License Required

Work Environment

The position is hybrid, 2 days onsite/week in Sacramento, must be flexible w/ days Job Type & Location This is a Contract to Hire position based out of Sacramento, CA. Pay And Benefits The pay range for this position is $38.00 - $43.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jan 9, 2026.

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