Optum-posted about 1 year ago
$40,498 - $79,206/Yr
Full-time
Arcadia, CA
Insurance Carriers and Related Activities

The LVN Case Manager - Utilization Management role at UnitedHealth Group involves overseeing medical necessity reviews for various healthcare services. This position is integral to ensuring that patients receive appropriate care while adhering to established guidelines and regulations. The role offers the flexibility of remote work and requires collaboration with various healthcare professionals to communicate service authorizations or denials effectively.

  • Conduct medical necessity reviews for inpatient, outpatient, home health, injectable medications, and DME/Orthotics/Prosthetics.
  • Utilize the Health Plan's Evidence of Coverage and Benefits, MCG guidelines, and CMS website for accurate assessments.
  • Complete all required documentation accurately and in a timely manner.
  • Collaborate daily with the UM Referral Management team, including Care Coordinators and Medical Directors.
  • Communicate authorization or denial of services to relevant parties, including patients and healthcare providers.
  • Meet or exceed productivity targets and maintain Quality Audit compliance.
  • Safeguard and disclose patient information in accordance with HIPAA standards.
  • Graduation from an accredited Licensed Vocational Nurse program.
  • Active, unrestricted LVN license in California.
  • 2+ years of experience in referrals and utilization management.
  • 3+ years of experience as an LVN/LPN.
  • Experience in an HMO or Managed Care setting.
  • General knowledge of medical terminology and ICD-10 and CPT/HCPCS coding.
  • 401(k) matching
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
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