Licensed Vocational Nurse

1 week ago


Dallas, Texas, United States Kris Anderson Consulting, LLC Full time
About the Job

This position is responsible for implementing and coordinating all utilization management functions relating to pre-certification of outpatient services. The LVN Case Manager in this capacity is responsible for coordinating authorizations and notifications.

Key Responsibilities
  • Clear understanding of managed healthcare and utilization management principles
  • Possess knowledge of applicable regulatory standards and ability to prepare for audits
  • Ability to maintain compliance and turnaround time standards for all UM assignments
  • Provide excellent customer service to members
  • Communicate effectively with a professional attitude
  • Be responsible and accountable for all assignments and deliverables
  • Follow company policies, procedures, and directives
  • Interact in a positive and constructive manner
  • Prioritize and multitask in a fast-paced work environment
Essential Job Outcomes
  • Inputs all information in referral system and ensures accuracy
  • Process referral authorization from providers in a timely manner using established protocols
  • Faxes back to requested provider information needed if not received
  • Gathers and assesses relevant documentation to compare with MCG/UM Criteria
  • Communicates with Utilization Physician Reviewer for follow-up and resolution of authorization referrals
  • Interacts effectively with providers, physician reviewers, and other departments using strong verbal and written communication skills
  • Applies UM criteria appropriately to authorization requests
  • Apply Timeliness Standards to processing of referrals (ICE Timelines Grids)
  • Review and update authorizations as needed
  • Requests medical records or other information as needed to justify referrals


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