Utilization Mgmt LPN/24/NUR130

Utilization Management LPN (Remote)

Job Title: Utilization Management LPN Location: Remote (United States) Employment Type: Full‑Time Schedule: Monday–Friday, 8:00 AM–5:00 PM Pay Rate: $16-$17/hr

Job Description

The Utilization Management LPN supports daily UM operations by performing timely and accurate authorization reviews, ensuring compliance with regulatory and health plan requirements, and maintaining workflow efficiency. This role is essential during periods of increased workload or staff leave and requires strong clinical judgment, communication skills, and attention to detail.

The LPN will work within a collaborative team of 10–11 members, including licensed nurses and UM support staff, in a fast‑paced environment focused on productivity and SLA performance.

Responsibilities

• Review and process authorization requests (consults, follow‑ups, procedures).
• Apply medical necessity criteria (e.g., InterQual) and health plan benefits.
• Document accurately and efficiently in EPIC.
• Communicate authorization decisions to providers (verbal and written).
• Maintain compliance with regulatory and audit requirements.
• Support high‑volume workloads and provide coverage during staff absences.
• Assist with redirection, benefit clarification, and care coordination.
• Meet productivity, quality, and SLA benchmarks.

Required Qualifications

• Active LVN/LPN license (Compact State or Texas).
• 2+ years of clinical experience (UM or managed care preferred).
• Strong knowledge of medical terminology and clinical workflows.
• Experience applying medical necessity criteria (e.g., InterQual).
• Excellent written and verbal communication skills.
• Ability to multitask and meet deadlines in a remote environment.

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