Utilization Management LVN

3 hours, 23 minutes ago
Full-time
Junior
Operations
WelbeHealth

WelbeHealth

WelbeHealth is a full-service healthcare company that offers personalized support to help seniors age well at home and in their community. Their Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive services at no cost, including ...

Family Services
251-1K
Founded 2015
$31M raised

Description

  • Conduct chart audits of consult summaries, imaging results, procedure summaries, and related records to determine whether additional follow-up services are needed.
  • Oversee clinical inboxes, email inboxes, and fax queues to ensure documents and authorization requests are handled appropriately.
  • Identify, document, and correct inconsistencies and gaps between participants’ charts and authorizations in the UM system.
  • Review prior authorization requests for medical necessity and alignment with participants’ care plans.
  • Evaluate authorization requests for routine office visits, procedures, and durable medical equipment (DME).

Requirements

  • Minimum of 1 year of chart auditing or utilization management review experience.
  • Knowledge of Medicare and Medicaid utilization management regulations.
  • Unencumbered LVN license.
  • Ability to work in a utilization management environment supporting authorization review and chart reconciliation.
  • Compensation is based on experience and relevant qualifications.
  • Willingness to comply with the company’s COVID-19 vaccination policy, including proof of vaccination or a vaccine declination form prior to employment.

Benefits

  • Base salary plus bonus.
  • Competitive total rewards package.
  • Medical, dental, and vision insurance coverage.
  • 17 days of personal time off, 12 paid holidays annually, and sick time.
  • 401(k) savings plan with company match.
  • Advancement opportunities with a track record of internal hiring and promotion.
  • Additional benefits.
  • Compensation range of $35.87 to $47.36 USD per hour.

Interested in this position?

Apply directly on the company website

Apply Now

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