Utilization Management LVN
WelbeHealth is transforming senior care by providing an all-inclusive healthcare option for vulnerable seniors. The Utilization Management LVN is responsible for auditing authorization requests and ensuring compliance with medical guidelines to provide timely and quality care.
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
Skills
- Minimum of one (1) year of chart auditing or UM review experience
- Knowledgeable in areas of Medicare and Medicaid UM regulations
- Unencumbered LVN licensure
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!
- 401(k) match
- Comprehensive healthcare coverage
- A broad range of additional benefits
Company Overview
Company H1B Sponsorship