LPN – Utilization Management (Shift Care Team)

This is a remote position.

Key Responsibilities:

• Conduct utilization management reviews, including concurrent reviews of Shift Care pediatric home care services.
  

• Assess medical appropriateness of services using established medical guidelines and benefit determinations.
  

• Collaborate with RNs, care coordinators, and healthcare professionals to ensure appropriate care planning.
  

• Communicate with providers, patients, and families regarding service authorizations and determinations.
  

• Maintain accurate documentation and compliance with Medicaid and health plan policies.
  

• Utilize electronic systems, including Microsoft Word, Excel, and other healthcare software.
  

Qualifications:

• Active, unrestricted LPN license in the state of Pennsylvania.
  

• 3-5 years of nursing experience in pediatrics, utilization management, or home care/clinical settings.
  

• Experience with Medicaid and health plan processes is a plus.
  

• Strong oral and written communication skills.
  

• Proficiency in Microsoft Word, Excel, and other computer applications.
  

Why Apply?

• Join a team committed to providing high-quality pediatric home care services.
  

• Use your expertise in utilization management to positively impact patient care.
  

• Competitive salary and benefits package offered by our client.
  

If you meet the qualifications and are passionate about pediatric home care and utilization management, we encourage you to apply today!