LVN UR Kelsey-Seybold Clinic
UnitedHealth Group•Pearland, TX
•$20 - $36•Onsite
About The Position
The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested medical and surgical procedures, services and admissions for HMO, PPO and POS products. The UR LVN nurse will serve as facilitator of communication with clinic, payor and other customers.
Requirements
- Licensed Vocational Nurse
- CEU requirement
- TX LVN license
- 2+ years of utilization review experience at heath plan, ACO, IPA, or provider group OR 3+ years of diverse clinical experience, including acute care or similar care
- Good organization and communication skills
- HMO, PPO and POS insurance knowledge
- Valid Driver’s license
Nice To Haves
- Computer and Coding experience
Responsibilities
- Data entry of all UR requests into the Kelsey-Seybold data system
- Verifies eligibility
- Obtains benefit interpretation from insurance company
- Reviews request and chart to determine medical necessity by using internal criteria
- Approves request or defers to insurance review and assists with MD review
- Communicates with respective payor to obtain pre-certification authorization
- Serves as resource to physicians, staff and patients regarding review process
- Clarifies UR request discrepancies with office submitting or insurance company
- Other duties as assigned
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
