Utilization Review Spec LVN Remote - Kelsey Seybold Clinics - Remote

Explore opportunities with reputed company, part of the reputed company family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout reputed company. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and reputed company total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to determine medical necessity for health care services requiring authorization prior to rendering services to members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing requests for medical and surgical procedures, services and admissions. The Utilization Review Specialist communicates with providers regarding pertinent information needed for medical review to ensure service reputed company are determined reputed company appropriate timeframes. This position will serve as a liaison to the Grievance and Appeals Department for Medicare Advantage appeals. The Utilization Review Specialist (LVN) is responsible for completing and reviewing denial letters in accordance with Texas Department of Insurance (TDI) and/or Centers for Medicare & reputed company Services (CMS) and health plan requirements. The Utilization Review Specialist (LVN) will serve as liaison and primary reputed company of contact for add-on procedures performed at the KS Ambulatory Surgery Center (ASC). The Utilization Review Specialist (LVN) will support the Utilization Review quality assurance initiatives, including mock audits, to ensure compliance. The Utilization Review Specialist will be flexible and adapt to changes in policies and procedures, new techniques, and additional responsibilities as assigned to meet changing business needs. If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as reputed company development for other roles you may be interested in. Required Qualifications:

• Licensed Vocational Nurse
• Active Texas RN license or multistate compact RN license
• 5+ years of utilization review experience at a health plan, ACO, IPA, or provider group
• HMO, PPO, and POS insurance knowledge

Preferred Qualifications:

• CEU requirements must be maintained
• Certification in area of specialization
• Experience working with insurance (HMO, PPO, and POS) companies to obtain authorizations and pre-certification for medical services
• Consistent and reputed company attendance at employer worksite is an essential job requirement
• Proven excellent verbal and communication skills, and organizational skills
• Proven solid organization and communication skills
• Bilingual
• Active Driver's License
• reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will reputed company from $20.38 to $36.44 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. OptumCare is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job