UM Licensed Vocational Nurse

Job Description:

The Utilization Management LVN supports the UM team by conducting medical necessity reviews, coordinating authorizations, and ensuring appropriate utilization of healthcare services in accordance with established guidelines. This role requires strong clinical judgment, attention to detail, and excellent communication skills to effectively collaborate with providers, members, and internal teams.

Responsibilities:

• Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and appropriateness of care
• Apply established criteria such as MCG or InterQual to assess clinical documentation
• Assist with processing prior authorization requests and determining level of care
• Collaborate with RNs, physicians, and other clinical staff to ensure coordinated, timely reviews
• Communicate determinations to providers and members in a timely and professional manner
• Maintain accurate documentation of clinical reviews, determinations, and communications in the system
• Identify and escalate cases that do not meet criteria to the appropriate clinical reviewer
• Ensure compliance with regulatory and accreditation standards including NCQA, CMS, and state-specific guidelines
• Participate in team meetings, trainings, and audits to ensure quality and consistency
• Support special projects or initiatives as assigned by leadership

Qualifications:

• Active and unrestricted LVN license in an eNLC (Enhanced Nurse Licensure Compact) state with multistate privileges
• 3+ years of Nursing experience
• 1+ years of Utilization Management experience
• Familiarity with medical terminology, utilization management guidelines, and clinical documentation standards
• Proficiency in Microsoft Office and experience working with healthcare systems or electronic medical records
• Strong organizational and time management skills with the ability to work independently
• Excellent written and verbal communication skills

Compensation Highlights

• Base Pay: up to $35 per hour
• Pay frequency: Weekly pay

Schedule Highlights

• Training Schedule: 2 weeks, Monday – Friday; 8:00 AM - 5:00 PM CST
• Production Schedule: Monday – Friday; 8:00 AM - 5:00 PM CST

Benefits:

• Medical, Dental, and Vision coverage.
• Life Insurance.
• Short-Term and Long-Term Disability options.
• Flexible Spending Account (FSA).
• Employee Assistance Program.
• 401(k) with employer contribution.
• Paid Time Off (PTO).
• Tuition Reimbursement.