Integra is looking for a LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating with our Medical Director to perform benefit and medical necessity reviews and appeals within an NCQA-compliant UM program.

Salary: $60,000.00/annual

JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES

The UM Nurse’s responsibilities include but are not limited to:

+ Perform pre-service and post service UM authorization reviews utilizing federal and state mandates, plan benefit language and NCDs/LCDs as criteria for medical necessity reviews

+ Work with non-clinical team to obtain additional clinical information, as needed

+ Approve requests that meet eligibility, benefit, and medical necessity criteria

+ Refer cases to the Medical Director that do not meet medical necessity criteria

+ Refer cases to in...