LPN Utilization Review Specialist
5 days ago
We are seeking an experienced LPN to join our team as a Utilization Review Specialist. In this role, you will be responsible for reviewing requests for prior authorization of outpatient and inpatient services for Commercial and Medicare product lines.
Key Responsibilities- Utilize evidenced-based criteria and/or VIVA HEALTH internally developed criteria to review provider requests for medical necessity.
- Coordinate authorizations including specialist referrals, outpatient therapies, surgeries, durable medical equipment (DME), and pharmacy services both internally and externally.
- Ensure services authorized are covered benefits and medically necessary by citing relevant criteria, certificate of coverage, or evidence of coverage.
- Forward potential denials to the Medical Director or designee and any other services requiring administrative review.
- High School Diploma or GED
- 1-3 years' experience as an LPN in a hospital setting, private physician or ancillary vendor's office
- Current LPN License in good standing with the State of Alabama Board of Nursing
- Licensed Practical Nurse Certification
- Utilization review or precertification experience utilizing InterQual or Milliman guidelines
- Relevant customer service or call center experience
Salary Range: $55,000 - $65,000 per year based on experience and qualifications.
-
LPN Utilization Review Specialist
1 day ago
Birmingham, Alabama, United States viva health Full timeViva Health LPN Utilization Review Job DescriptionSalary: $55,000 - $65,000 per yearAbout Viva HealthViva Health is a healthcare provider dedicated to delivering high-quality services to its patients. We are seeking an experienced Licensed Practical Nurse (LPN) to join our team as a Utilization Review Specialist.Job SummaryThe LPN Utilization Review...
-
Clinical Nurse Specialist
6 days ago
Birmingham, Alabama, United States Community Health System Full timeJob SummaryWe are seeking a skilled Clinical Nurse Specialist to lead our Utilization Review team. In this role, you will be responsible for overseeing the analysis of medical services and procedures, ensuring that they are necessary, appropriate, and efficient.About Grandview Medical CenterGrandview Medical Center is a 434-bed regional referral center and...
-
LPN - Medical Records Specialist
5 days ago
Birmingham, Alabama, United States NHS Management Services Full timeJob SummaryWe are seeking a highly skilled Licensed Practical Nurse (LPN) to join our team as a Medical Records Specialist. In this role, you will be responsible for preparing and maintaining accurate medical records, ensuring compliance with regulations and standards.About UsNHS Management Services is a dynamic organization dedicated to providing...
-
LPN MedSurg 5D Care Specialist
1 day ago
Birmingham, Alabama, United States Children's of Alabama Full timeJob Title: LPN MedSurg 5D Care SpecialistAt Children's of Alabama, we are seeking a compassionate and skilled Licensed Practical Nurse (LPN) to join our medical surgical unit. As an LPN MedSurg 5D Care Specialist, you will play a vital role in providing high-quality patient care to an assigned group of patients.About the RoleAssess, plan, implement, and...
-
Document Review Specialist
5 days ago
Birmingham, Alabama, United States Regions Bank Full timeAt Regions Bank, we believe in offering performance-driven individuals a place where they can build a career and succeed.We are seeking a skilled Enterprise Operations Document Review Specialist to ensure loan documentation is complete and accurate according to State and Federal regulations, as well as our company policies and guidelines.This role is ideal...
-
NHS Unit Coordinator LPN Position
2 days ago
Birmingham, Alabama, United States NHS Management Services Full timeAt NHS Management Services, we offer a unique opportunity to work in a dynamic environment where you can make a real impact on the lives of our patients. Our team is passionate about delivering exceptional care and support, and we're looking for an experienced LPN Nurse Unit Coordinator to join us.About the RoleWe are seeking a qualified LPN Nurse Unit...
-
Senior Credit Risk Review Specialist
3 weeks ago
Birmingham, Alabama, United States Regions Bank Full timeAbout this RoleThis role is part of the Credit Risk Review team at Regions Bank, where we work to ensure the bank's credit risk management practices are sound and compliant with regulations. As a Credit Risk Review Examiner, you will play a critical role in assessing and reporting on the credit risk within assigned consumer or small business portfolios.Key...
-
Medical Care Specialist
5 days ago
Birmingham, Alabama, United States Diversicare Healthcare Services & Diversicare Ther Full timeCareer Opportunities with DiversicareAs a Licensed Practical Nurse (LPN) at Diversicare, you will have the opportunity to make a meaningful difference in the lives of our residents. Our team of healthcare professionals is dedicated to providing exceptional care and support to our residents, and we are seeking a skilled LPN to join our team.Key...
-
Resident Care Specialist LPN
1 day ago
Birmingham, Alabama, United States Greenbriar at the Altamont Full timeWe are seeking a skilled Licensed Practical Nurse (LPN) to join our team at Greenbriar at the Altamont. As a key member of our healthcare staff, you will be responsible for providing direct care to residents in accordance with their care plans, policies, and procedures.Key ResponsibilitiesThe Licensed Practical Nurse (LPN) will be responsible for:Providing...
-
Skilled Homecare LPN
5 days ago
Birmingham, Alabama, United States Amedisys Full timeAmedisys is a leading provider of home health, hospice and high-acuity care. As a skilled Licensed Practical Nurse (LPN), you will be part of a team dedicated to delivering compassionate, patient-centered care to those in need.CompensationYour compensation reflects the cost of labor across various U.S. geographic markets. You can expect a salary range of $26...
-
Birmingham, Alabama, United States Community Health System Full timeOverviewAt Grandview Medical Center, we prioritize providing exceptional care to our patients. As a Behavioral Health Licensed Practical Nurse (LPN), you will be part of a dedicated team that makes a positive impact on the lives of others.Job SummaryWe are seeking a compassionate and skilled LPN to join our team in a night shift role. In this position, you...
-
LPN Substitute Nurse
6 days ago
Birmingham, Alabama, United States Alabama Department of Education Full timeJob DescriptionAs a Substitute Nurse with the Alabama Department of Education, you will play a vital role in providing health services to students within the school system. Your primary responsibility will be to provide direct student/patient care, including first aid, administering medication, and performing invasive procedures as needed.You will also be...
-
Healthcare Professional
1 day ago
Birmingham, Alabama, United States Developmental Disability Management Services Full timeJob DescriptionWe are seeking a skilled and compassionate Licensed Practical Nurse (LPN) to join our team at Developmental Disability Management Services. As an LPN, you will play a vital role in providing high-quality care to individuals with intellectual disabilities in our community.About the RoleAdminister enteral nutrition and medications to bed-bound...
-
Nursing Care Specialist PRN
18 hours ago
Birmingham, Alabama, United States YesCare Corp Full timeAre you passionate about delivering high-quality healthcare to patients in correctional facilities? Do you have a strong desire to make a difference in the lives of those who need it most?About YesCare HealthYesCare is a pioneering provider of correctional healthcare, committed to delivering exceptional care and compassion to our patients. As a Nursing Care...
-
Employment Law Specialist
5 days ago
Birmingham, Alabama, United States Larson Maddox Full timeEmployment Law Specialist PositionLarson Maddox, a leading AMLAW Top #100 law firm, is recruiting an experienced Employment Law Specialist to join their labor department. As a key contributor, you will advise management on labor laws, represent clients in negotiations with labor unions, and review labor practices for compliance with relevant...
-
Collateral Risk Management Specialist
5 days ago
Birmingham, Alabama, United States Regions Bank Full timeEnterprise Operations Collateral Specialist RoleWe are seeking a skilled Collateral Risk Management Specialist to join our team at Regions Bank.About the JobThe primary responsibility of this role is to perfect collateral to reduce the risk of loan loss. This involves reviewing and analyzing documentation, as well as communicating with various stakeholders...
-
Education Specialist
6 days ago
Birmingham, Alabama, United States Alabama Department of Education Full timeJob Overview:We are seeking a highly skilled and motivated Education Specialist - Mathematics to join our team at the Alabama Department of Education. The successful candidate will be responsible for developing and implementing effective educational programs for students in grades 6-12, utilizing a designated course of study, appropriate materials and...
-
Traveling School Nurse Specialist
2 weeks ago
Birmingham, Alabama, United States Alabama Department of Education Full timeJob SummaryWe are seeking a highly skilled and experienced Traveling School Nurse Specialist to join our team at the Alabama Department of Education.About the RoleThe successful candidate will provide health services to students within the school system, adhering to the accepted Standards of School Nursing Practice as published by the American Nurses...
-
Platform Support Specialist
2 months ago
Birmingham, Alabama, United States Argent Financial Group Full timeJob OverviewArgent Financial Group is a leading wealth management firm seeking a skilled Systems Specialist to maintain our system software platforms. The ideal candidate will have a strong background in operational systems, troubleshooting, and reporting.The Systems Specialist will be responsible for:Maintaining system software platformsAssisting user...
-
Financial Services Compliance Specialist
5 days ago
Birmingham, Alabama, United States Saxon Global Full timeSaxon Global seeks a Financial Services Compliance Specialist to join their team. The successful candidate will have 3+ years of experience working with Firco Compliance Link and a strong understanding of business analysis activities, tasks, tools, and deliverables.Job DescriptionThe Firco Compliance Analyst role involves working with RDS business to ensure...