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Prior Authorization Nurse, LVN

Los Angeles, CA 75248

Employment Type: Contract Industry: Healthcare Job Number: 8891 Pay Rate: 34.00

Job Description


Job Title: Prior Authorization Nurse (LVN/RN – California License)
Employment Type: Contract
Location: Fully Remote
Schedule: Monday – Friday | 8:00 AM – 5:00 PM PST
Pay Rate: $30 – $34 per hour
License Requirement: Active LVN or RN License (California)
Job Summary
Wheeler Staffing Partners is hiring a Prior Authorization Nurse for a fully remote contract position. This role supports medical management functions by reviewing, screening, coordinating, and processing referrals for medical services. The nurse will utilize review criteria, policies, and guidelines to ensure appropriate, cost-effective, and high-quality care is delivered to members in the correct setting.
Essential Duties and Responsibilities

  • Process referral determinations using Milliman Care Guidelines

  • Identify and refer complex cases to medical director

  • Ensure accurate coding and letter documentation (denials, deferrals, modifications)

  • Select appropriate, contracted providers

  • Verify member eligibility and health plan benefits

  • Route records and trigger appropriate determination notices

  • Maintain compliance with turnaround time standards (ICE TAT)

  • Meet or exceed quality and productivity standards

  • Collaborate with providers and medical directors

  • Identify and refer members to case management or disease management programs

  • Attend required training and team meetings

  • Maintain confidentiality of records and documentation

  • Communicate and collaborate across internal departments
Required Qualifications

  • Active LVN or RN license in the state of California

  • 3–5 years of utilization review experience

  • 2 years of managed care or medical management experience preferred

  • ICD-9 and CPT coding knowledge preferred

  • Experience with EZ-CAP system preferred

  • Proficiency in Microsoft Word, Excel, Outlook

  • Effective verbal and written communication skills

  • Ability to work independently in a remote setting
Education and Experience

  • Minimum Education: LVN License (California)

  • Preferred Education: Bachelor’s Degree in Nursing (BA or BSN)

  • Minimum Experience:

  • 3–5 years acute care experience

  • 2 years health plan utilization review or equivalent

  • Preferred Experience:

  • 5 years of utilization review in a health plan setting

  • 5 years acute care experience

  • 1 year ICU or Emergency Room experience
    About Wheeler Staffing Partners
    Wheeler Staffing Partners is a professional staffing firm that connects skilled professionals with top employers across the country. We are committed to supporting healthcare providers and organizations with high-quality staffing solutions.

    To apply, submit your resume today. Qualified candidates will be contacted promptly.

    • Meet Your Recruiter

    Rachel Wiseman
    Recruiter

     

     

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