APN
is exploring opportunities for experienced
Utilization Management (UM) Nurses
who are currently based in India and Philippines; hold an
active and unrestricted California LVN license
.

This is a remote, full time opportunity supporting a U.S.-based healthcare organization. The role involves reviewing clinical cases to determine medical necessity using established clinical guidelines and criteria.

Key Responsibilities
- Perform prospective and pre-service medical necessity reviews.
- Review clinical documentation and apply appropriate criteria, including
MCG, Medicare, Medicaid/Medi-Cal, and health-plan-specific guidelines
.
- Support concurrent review of cases and appropriate discharge/transition-of-care processes.
- Collaborate with the client's clinical team and Medical Director on cases requiring additional review.
- Accurately document utilization review findings.
- Meet established quality and productivity expectations.
- Serve as a clinical resource to non-clinical team members when required.

Required Qualifications




- Active and unrestricted California Licensed Vocational Nurse (LVN) license - mandatory
- Minimum
2 years of experience in Utilization Management, Utilization Review, or medical necessity review
- Experience applying
MCG criteria
or similar clinical guidelines
- Good understanding of U.S. healthcare and clinical documentation
- Strong written and verbal English communication skills
- Comfortable working remotely and independently

Work Location & Hours
- Location:
Remote - India, Philippines
- Schedule:
Full-time
- Must be able to work
8:00 AM-5:00 PM Pacific Time
- Some weekend and U.S. holiday coverage may be required

Preferred
- Certification in Managed Care Nursing (CMCN)
- Previous experience supporting a U.S. health plan, managed care organization, utilization management operation, or healthcare services organization
- Experience working remotely for a U.S.-based healthcare organization

If you are currently based in India, hold an a

📌 Utilization Management (Noida)
🏢 APN Consulting
📍 Noida