UtilizationManagementLVN

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, while functioning as both a care provider and care plan to we serve. Our Health Plan Services team plays a critical role in our participants’ journeys, and our Utilization Management team ensures that we provide timely, quality, compliant, and cost-effective care to our participants. The Utilization Management LVN is accountable for the review and audit of authorization requests to ensure services meet standard medical guidelines. Essential Job Duties: Chart audits of items including but not limited to consult summaries, imaging results, and procedure summaries to determine if additional follow up services are requested Oversee departmental clinical inboxes, email inboxes, and fax queues to ensure appropriate handling of documents and authorization requests Identify, document, and correct inconsistencies and gaps in participants’ charts with authorizations in the UM system Review prior authorization requests for medical necessity and alignment with participants’ care plans, including routine office visits, procedures, and DME Job Requirements: Minimum of one (1) year of chart auditing or UM review experience Knowledgeable in areas of Medicare and Medicaid UM regulations Unencumbered LVN licensure Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for. Medical insurance coverage (Medical, Dental, Vision) Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and sick time 401K savings + match Advancement opportunities - we’ve got a track record of hiring and promoting from within, meaning you can create your own path! And additional benefits Compensation consists of base salary plus bo