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UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Utilization Review Specialist LVN
Location
United States
Posted
51 days ago
Salary
$20 - $36 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Utilization Review Specialist LVN
UnitedHealth Group
Role Description The Utilization Review Specialist (LVN) is responsible for: - Conducting medical reviews, benefit verification, and applying criteria to determine medical necessity for health care services requiring authorization prior to rendering services to members. - Serving as a liaison in reviewing requests for medical and surgical procedures, services, and admissions. - Communicating with providers regarding pertinent information needed for medical review to ensure service decisions are determined within appropriate timeframes. - Completing and reviewing denial letters in accordance with Texas Department of Insurance (TDI) and/or Centers for Medicare & Medicaid Services (CMS) and health plan requirements. - Acting as liaison and primary point of contact for add-on procedures performed at the KS Ambulatory Surgery Center (ASC). - Supporting the Utilization Review quality assurance initiatives, including mock audits, to ensure compliance. - Being flexible and adapting to changes in policies and procedures, new techniques, and additional responsibilities as assigned to meet changing business needs. If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Qualifications - Licensed Vocational Nurse - Active Texas RN license or multistate compact RN license - 5+ years of utilization review experience at a health plan, ACO, IPA, or provider group - HMO, PPO, and POS insurance knowledge Requirements - CEU requirements must be maintained - Certification in area of specialization - Experience working with insurance (HMO, PPO, and POS) companies to obtain authorizations and pre-certification for medical services - Consistent and prompt attendance at employer worksite is an essential job requirement - Proven excellent verbal and communication skills, and organizational skills - Proven solid organization and communication skills - Bilingual - Active Driver’s License Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) - Hourly pay for this role will range from $20.38 to $36.44 per hour based on full-time employment
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