Licensed Vocational Nurse LVN/LPN PA Utilization Management Nurse
2 weeks ago
We are seeking a skilled Licensed Vocational Nurse LVN/LPN to join our Utilization Management team in San Antonio, TX. As a Utilization Management Nurse, you will play a critical role in ensuring that our patients receive the necessary care and services in a timely and efficient manner.
Key Responsibilities- Monitor healthcare services to determine the level of review required by service type
- Collect benefit, criteria, and clinical information to perform clinical review decisions
- Communicate with providers and patients regarding the outcome of review
- Expedite requests that are required within 72 hours or have a high acuity of healthcare required
- Verify eligibility with accurate identification of patient benefit according to specific health plan enrollee
- Notify patient and providers of referral determination in a professional manner
- 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
- Proficient in PC software computer skills
- 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
- InterQual or Milliman Knowledge / experience
- ICD-10, CPT coding knowledge / experience
- Utilization Review / Management experience
- Telephonic and/or telecommute experience
- Bilingual English/Spanish
Optum 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 with over 16,000 doctors' offices. Our focus is simple: we're innovators in preventative health care, striving to change the face of health care for seniors.
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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