Utilization Management LPN
ALLMED Staffing
- New York, New York, United States
- New York, New York, United States
Über
Review and process authorization requests, including consults, follow-up visits, and procedures Apply medical necessity criteria such as InterQual and evaluate plan benefits Ensure accurate and timely documentation within EPIC or similar systems Communicate authorization decisions and status updates to providers verbally and in writing Maintain compliance with regulatory, quality, and audit requirements Support high-volume work queues and assist with coverage needs Coordinate redirection of services, benefit clarification, and continuity of care Meet established productivity, turnaround time, and quality benchmarks Assist with workflow improvements and departmental goals as needed
Qualifications: Required:
Active LVN/LPN license in a Compact State or Texas Minimum 2 years of clinical experience, preferably in utilization management or managed care Strong knowledge of medical terminology and clinical workflows Experience applying medical necessity criteria such as InterQual Excellent communication, documentation, and organizational skills Ability to multitask, prioritize workload, and meet deadlines
Preferred:
Previous Utilization Management or Prior Authorization experience Experience with EPIC and/or IQ Cloud systems Knowledge of Medicare Advantage and Commercial plan requirements Strong understanding of compliance, audits, and regulatory processes Ability to work independently in a remote environment
Additional Information:
License Required: Yes – Active LVN/LPN (Compact State or Texas) Dress Code: Business casual (remote-appropriate) Interview Process: One-round video interview
Sprachkenntnisse
- English
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