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LVN Utilization Review Specialist - Kelsey Seybold Clinic: Remote
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Job Description
- Req#: 2333524
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $35.72 per hour
- Comprehensive benefits package, including equity stock purchase and 401k contribution
- Opportunity for career advancement and growth within the organization
- Flexibility to work remotely for Texas residents
- Recognition and rewards for performance in a supportive environment
- Chance to make a positive impact on patient care and health outcomes
What to Expect (Job Responsibilities):
- Conduct medical reviews and benefit verification to determine medical necessity for healthcare services
- Serve as a liaison in reviewing requests for medical and surgical procedures, services, and admissions
- Communicate with providers to gather pertinent information for medical review and ensure timely service decisions
- Complete and review denial letters in accordance with Texas Department of Insurance and CMS requirements
- Support quality assurance initiatives, including mock audits, to ensure compliance with policies and procedures
What is Required (Qualifications):
- Licensed Vocational Nurse (LVN) with a valid Texas license
- Minimum of 5 years of utilization review experience at a health plan, ACO, IPA, or provider group
- Knowledge of HMO, PPO, and POS insurance
- Maintenance of CEU requirements
- Valid driver's license
How to Stand Out (Preferred Qualifications):
- Certification in area of specialization
- Bilingual capabilities
- Experience working with insurance companies to obtain authorizations for medical services
- Excellent verbal communication and organizational skills
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