Utilization Management LVN
About The Position
At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, while functioning as both a care provider and care plan to we serve. Our Health Plan Services team plays a critical role in our participants’ journeys, and our Utilization Management team ensures that we provide timely, quality, compliant, and cost-effective care to our participants. The Utilization Management LVN is accountable for the review and audit of authorization requests to ensure services meet standard medical guidelines.
Requirements
- Minimum of one (1) year of chart auditing or UM review experience
- Knowledgeable in areas of Medicare and Medicaid UM regulations
- Unencumbered LVN licensure
Responsibilities
- Chart audits of items including but not limited to consult summaries, imaging results, and procedure summaries to determine if additional follow up services are requested
- Oversee departmental clinical inboxes, email inboxes, and fax queues to ensure appropriate handling of documents and authorization requests
- Identify, document, and correct inconsistencies and gaps in participants’ charts with authorizations in the UM system
- Review prior authorization requests for medical necessity and alignment with participants’ care plans, including routine office visits, procedures, and DME
Benefits
- Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
- Work/life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
- Advancement opportunities - We’ve got a track record of hiring and promoting from within, meaning you can create your own path!
- And additional benefits
- Salary/Wage base range for this role is $35.87 - $47.36 hourly+ Bonus. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
