Utilization Management LVN

WelbeHealth • Los Angeles, CA

2d

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)
• 17 days of personal time off (PTO), 12 holidays observed annually, and sick time
• 401K savings + match
• Advancement opportunities
• Competitive total rewards package

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree