PA Licensed Practical Nurse

2 weeks ago


New Braunfels TX, United States UnitedHealth Group Full time

Job Summary:

We are seeking a PA Licensed Practical Nurse to join our team in Texas. As a Utilization Management Specialist, you will be responsible for managing the pre-certification process for healthcare services, ensuring timely and accurate application of criteria and medical necessity.

Key Responsibilities:

  • Monitor healthcare services for level of review required by service type
  • Collect benefit, criteria, and clinical information for clinical review decisions
  • Communicate with providers and patients regarding review outcomes
  • Expedite requests within 72 hours or with high acuity of healthcare required
  • Verify eligibility with accurate identification of patient benefit
  • Notify patients and providers of referral determination

Requirements:

  • High school diploma or GED
  • Current LVN license in state of Texas
  • Experience in physician office as clinical LVN
  • Sound knowledge of managed care, medical terminology, referral process, and ICD-9 coding

Preferred Qualifications:

  • 4+ years of clinical experience in primary care physician office or hospital setting
  • 2+ years of experience in managed care or referral management position
  • Prior Authorization experience

About UnitedHealth Group:

UnitedHealth Group is a clinician-led care organization that is changing the way clinicians work and live. We are a network of doctors, specialists, and other medical professionals that specialize in providing care for more than 1 million older adults.

Why Choose UnitedHealth Group:

We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution. We are an equal employment opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



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