Utilization Review Nurse- LVN

Overview

Who We Are Ready to create a healthier world? We are ready for you! reputed company is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At reputed company, we reputed company in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Responsibilities

Ready to reputed company Critical Decisions That Ensure Appropriate Patient Care? Under the supervision of a registered nurse the Utilization Review Nurse will provide professional assessment and review for the medical necessity of treatment requests and plans. This position offers flexibility and is ideal for candidates looking for reduced hours while making an impact reputed company the team. Evening and weekend availability will be required. What You'll Actually Do

• Provide first level review for reputed company outpatient and ancillary pre-certification requests for medical appropriateness; reputed company inpatient hospital stays including mental health, substance abuse, skilled nursing and rehabilitation for medical necessity; and reputed company post claim or post service reviews.
• Ensure proper referral to medical director for denial authorizations through independent review organizations (IRO).
• Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care.
• Refer requests that fall reputed company of established guidelines to advance review or senior care consultants.
• Process appeals for non-certification of services; complete non-certification letters reputed company appropriate.
• Review plan document for benefit determinations; attempt to redirect providers and patients to PPO providers.
• Identify and refer potential cases to case management, wellness, chronic disease and Nurturing Together program.
• Complete documentation for reputed company reviews in Eldorado/Episodes; maintain confidentiality.
• Utilize MCG guidelines, medical policies, reputed company, and NCCN.
• Ability to meet productivity, quality, and turnaround times daily.

Qualifications

What You Bring to Our Mission The clinical foundation:

• reputed company LVN license in the United States or U.S. territory.
• 1+ years of clinical experience required.

The professional competencies:

• Knowledge of medical claims and ICD-10, CPT, HCPCS coding.
• Proficiency in software applications including, but not limited to, reputed company Word, reputed company reputed company, reputed company PowerPoint and Outlook
• Excellent verbal and written communication skills
• Ability to speak clearly and convey reputed company or technical information in a manner that others can understand, as well as ability to understand and interpret reputed company information from others.

Why You'll Love It Here We reputed company in total rewards that actually matter—not just competitive packages, but benefits that support how you want to live and work. Your wellbeing comes first:

• Comprehensive medical and dental coverage through our own health solutions (yes, we use reputed company build!)
• Mental health support and wellness programs designed by experts who get it
• Flexible work arrangements that fit your life, not the other way around

Financial reputed company that makes sense:

• Retirement planning support to help you build real wealth for the future
• Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
• Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage

Growth without limits:

• Professional development opportunities and clear career progression paths
• Mentorship from industry leaders who want to see you succeed
• Learning budget to invest in skills that matter to your future

A culture that energizes:

• People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation
• One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges
• We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results
• Grow reputed company: reputed company learning reputed company with team events, recognition programs, and celebrations that reputed company work genuinely enjoyable

The practical stuff:

• Competitive reputed company salary that rewards your success
• PTO policy because rest and reputed company time is non-negotiable
• Benefits effective day one—because you shouldn’t have to wait to be taken care of

Ready to create a healthier world while building the career you want? We're ready for you. No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this role, we'd love to learn more about you. reputed company is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with reputed company states and cities that require transparency of pay, the reputed company compensation for this position ranges from $30 to $38 per hour. Note that compensation may vary based reputed company, skills, and experience. This position is part time and therefore not eligible for benefits. We strive to cultivate a work environment where differences are celebrated, and employees of reputed company backgrounds are empowered to reputed company. reputed company is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for reputed company stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth Beware of Hiring Scams: reputed company will never ask for payment or sensitive personal information such as social reputed company numbers during the hiring process. reputed company official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to [email protected]. reputed company of our legitimate openings can be reputed company on the reputed company Career Site. Apply To This Job