Altais
201 - 500 employees
Founded 2019
🏥 Healthcare
👥 B2C
🧘 Wellness
Healthcare • B2C • Wellness
Altais is a California-based healthcare provider network that unifies multiple medical brands to offer coordinated primary care, urgent care, specialty services, hospitals and labs, and mental and senior health across Northern and Southern California. The organization supports physicians and care teams with technology-enabled patient portals and value-based care partnerships, serving patients directly while also working with providers and partners to improve access, affordability, and care coordination.
Utilization Management Nurse, LVN – Casual
Job not on LinkedIn
🕒 6 days ago
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Altais
201 - 500 employees
Founded 2019
🏥 Healthcare
👥 B2C
🧘 Wellness
Healthcare • B2C • Wellness
Altais is a California-based healthcare provider network that unifies multiple medical brands to offer coordinated primary care, urgent care, specialty services, hospitals and labs, and mental and senior health across Northern and Southern California. The organization supports physicians and care teams with technology-enabled patient portals and value-based care partnerships, serving patients directly while also working with providers and partners to improve access, affordability, and care coordination.
📋 Description
• Interface with external agencies and representatives relative to the utilization management process, including health plans, medical providers, vendors and CMS. • Perform Utilization Review activities prospectively or post-service (retrospective) for elective/urgent hospital admissions and outpatient services as specified on the Prior Authorization List with complete and timely reports to members, providers and health plans as requested. • Assist medical directors with benefit interpretation, obtain additional medical necessity information and research issues. • Work closely with physicians, other healthcare and service providers, health plan representatives, care management staff and partners with UM Coordinators to provide medical management for incoming authorization requests. • Review the authorization request and medical information provided by the requesting provider for medical necessity and appropriateness, comparing information to current medical care criteria by health plan and as specified by BTP, CMS, CDC, NCQA and DMHC requirements.
🎯 Requirements
• LVN - Licensed Vocational Nurse of California Licensure required • Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMA, all value-based reimbursement models, and alternative payment systems preferred • 2 years recent relevant experience • Recent MCG or InterQual experience highly desired • Experience with ICD-9, CPT and HCPCS codes preferred
🏖️ Benefits
• Excellent medical, vision, and dental coverage • 401k savings plan with a company match • Flexible time off and 9 Paid Holidays
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