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Utilization Management LVN
3 months ago
We are looking for an experienced Utilization Management LVN seeking a new exciting opportunity
For immediate consideration, Please submit your resume to:
Fully Remote Pay:
$36hr
Utilization Management LVN Overview
The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization
requests from all lines of business using respective national/state, health plan, nationally
recognized guidelines. Responsible for reviewing proposed hospitalization, home care, and
inpatient/outpatient treatment plans for medical necessity
Utilization Management LVN Qualifications1. Current valid License as a Licensed Vocational Nurse.2. Minimum of 2 years of managed care experience3.
Demonstrated ability to work with automated systems, including electronic medicalrecords and MS Office products such as Word, Excel and Outlook.4.
Excellent customer service; ability to be an effective communicator5. Knowledge of federal, state and other applicable standards for clinical practice forassigned area(s) of responsibility.Utilization Management LVN Responsibilities1.
Responsible for the daily review and processing of referral authorizations in accordance toturnaround time (TAT) standards set by ICE/Health Plan2.
Works collaboratively with Hospitalists, hospital partners, and care teams to provideholistic patient care that is focused on high quality in a cost effective3.
Monitors ongoing services and their cost effectiveness; recommending changes to theplan as needed using clinical evidence-based criteria – Milliman, Interqual, CMS, NationalRecognized American Academy of Specific Specialty, Health Plan specific criteria.4.
Utilizes authorization matrix, ancillary rosters, DOFR, and/or delegation agreements todrive decision-making5. Maintains up to date knowledge of rules and regulations governing utilizationmanagement processes;6. Input data into the Medical Management system to ensure timeliness of referralprocessing.7. Verifies member benefits and eligibility upon receipt of the treatment authorizationrequest.INDMED
