- Clear understanding of managed healthcare, utilization management
- Possess knowledge of applicable regulatory standards and is able to prepare for audits based upon these standards
- Ability to maintain compliance and turnaround time standards for all UM assignments
- Provide excellent customer service to our members
- Communicate effectively with a professional attitude.
- Be responsible and accountable for all assignments and deliverables
- Follow company policies, procedures and directives
- Interact in a positive and constructive manner
- Prioritize and multitask in a fast-paced work environment
- Inputs all information in referral system and ensures that all information is accurate.
- Process referral authorization from providers in a timely manner, by utilizing established protocols.
- Faxes back to requested provider information needed if not received.
- Gathers and assess relevant documentation to compare with MCG/UM Criteria.
- Communicates with Utilization Physician Reviewer for follow-up and resolution of authorization referrals.
- Interacts effectively with providers, physician reviewers, and other departments using strong verbal and written communication skills on an on-going basis
- Applies UM criteria appropriately to authorization requests
- Apply Timeliness Standards to processing of referrals (ICE Timelines Grids)
- Review and update authorizations as needed
- Requests medical records or other information as needed to justify referrals
- Other duties as assigned
-
Office RN/LVN
2 weeks ago
VCM Healthcare LLC Farmers Branch, United StatesJob Description · Job DescriptionUnder the direction of the RN, assists in identifying the patient's/client's physical, psychosocial, and environmental needs as evidenced by documentation. · Participates in planning and implementing care in partnership with the patient/client, re ...
-
Bilingual LVN for Back Office
2 weeks ago
Advanced Allergy & Asthma Assocs Southlake, United StatesJob Description · Job DescriptionExcellent, full-time employment opportunity with competitive pay in an Allergy clinic. This candidate will be a key member of the clinic team responsible mainly for back-office clinical duties and shot clinic. Front office experience is preferable ...
-
LPN/LVN Medical office
5 days ago
Cook Children's Health Care System Flower Mound, TX, United States TemporaryFlower Mound Primary Care · PCP-Flower Mound · Shift: · First Shift (United States of America) · Functions in collaborative practice with physician(s) and/or nurse practitioner(s) in physician practice or clinic setting. Provides ambulatory nursing care as directed by physicia ...
-
CareHarmony LLC Dallas, United StatesCareHarmony's Care Coordinators (LPN) (LVN) work comprehensively with providers to deliver value-based care management initiatives for their patients. · CareHarmony is seeking an experienced Licensed Practical Nurse to work 100% Remote - LPN Nurse (LPN) (LVN) with at least 3 yea ...
-
Licensed Vocational Nurse
2 weeks ago
Pediatric Home Healthcare, LLC. Dallas, United StatesLicensed Vocational Nurse (LVN) · Dallas, TX · Pediatric Home Healthcare · Why choose Pediatric Home Healthcare? · Where children matter most A provider of home healthcare services, Pediatric Home Healthcare, LLC is a Skilled Private Duty Nursing Agency. We value children's well- ...
-
Licensed Vocational Nurse
3 weeks ago
Pediatric Home Healthcare, LLC. Dallas, TX, United StatesLicensed Vocational Nurse (LVN) Interested in learning more about this job Scroll down and find out what skills, experience and educational qualifications are needed. Dallas, TX Pediatric Home Healthcare Why choose Pediatric Home Healthcare? Where children matter most A provider ...
-
Registered Nurse
2 weeks ago
Elite Body Sculpture Dallas, United StatesRegistered Nurse (RN) · Our award winning, board-certified plastic and cosmetic surgeons and highly-trained staff members are among the elite in the specialty cosmetic surgery industry. We are passionate about making the patient experience truly remarkable. Our unified mission i ...
-
RN/LVN Pediatric Home Health Nurse
1 week ago
Children's Home Healthcare Dallas, United StatesJob Description · Job Description*THIS JOB REQUIRES AN RN/LVN LICENSE, NON-LICENSED INDIVIDUALS WILL BE REJECTED* · Sign-On Bonus up to $2500* · *Sign-on bonus is case specific and offered based on hours worked, speak to your recruiter for more information. · Monday-Friday days o ...
-
RN/LVN Pediatric Home Health Nurse-NIGHTS
1 week ago
Children's Home Healthcare Dallas, United StatesJob Description · Job Description*THIS JOB REQUIRES AN RN/LVN LICENSE, NON-LICENSED INDIVIDUALS WILL BE REJECTED* · Sign-on Bonus up to $1500* · *Sign-on bonus is case specific and offered based on hours worked, speak to your recruiter for more information. · Friday-Sunday Nights ...
-
RN/LVN Pediatric Home Health Nurse
2 weeks ago
Children's Home Healthcare Dallas, United StatesJob Description · Job Description*THIS JOB REQUIRES AN RN/LVN LICENSE, NON-LICENSED INDIVIDUALS WILL BE REJECTED* · Sign-On Bonus up to $2500* · *Sign-on bonus is case specific and offered based on hours worked, speak to your recruiter for more information. · Monday-Wednesdays 7a ...
-
LVN needed in Dallas-Fort Worth, TX
1 week ago
KidsCare Home Health Dallas, United StatesNurses, we are hiring KidsCare Home Health's private duty nursing services enhance our ability to ensure quality patient care by providing collaboration between our nurses and our therapists. This creates a cohesive and dedicated medical professionals team for the children entrus ...
-
Licensed Vocational Nurse
2 weeks ago
Elite Body Sculpture Dallas, TX, United StatesOur award winning, board-certified plastic and cosmetic surgeons and highly-trained staff members are among the elite in the specialty cosmetic surgery industry. We are passionate about making the patient experience truly remarkable. Our unified mission is to provide unparalleled ...
-
Licensed Vocational Nurse
2 weeks ago
AirSculpt Dallas, TX, United StatesOur award winning, board-certified plastic and cosmetic surgeons and highly-trained staff members are among the elite in the specialty cosmetic surgery industry. We are passionate about making the patient experience truly remarkable. Our unified mission is to provide unparalleled ...
-
Licensed Vocational Nurse/LVN
3 weeks ago
Texas Health Resources Dallas, United StatesLicensed Vocational Nurse (LVN) – Women's Health Specialists Fast-paced, high-volume clinic is looking for top skilled LVN Work location: 8160 Walnut Hill Lane, Suite 200, Dallas, TX 75231 Work hours: Full-time, 40 hours weekly, Monday thru Friday, 8:00a - 5:00p Women's Health Sp ...
-
Optum Dallas, TX , USA, United StatesOpportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical st ...
-
paramedic, rn, or lpn/lvn
2 weeks ago
Proesis Bio Dallas, TX , USA, United StatesProesis Biologics is a contemporary and forward-thinking human source plasma collection platform dedicated to improving the plasma donation journey for all stakeholders. We partner with communities and donors to supply the industry with the high-quality plasma necessary for treat ...
-
Licensed Vocational Nurse/LVN
3 weeks ago
Texas Health Resources Dallas, United StatesLicensed Vocational Nurse (LVN) – Heart & Vascular Specialists Fast-paced, high-volume clinic is looking for top skilled LVN Work location: 8440 Walnut Hill Lane, Suite 610, Dallas, TX 75231 Work hours: Full-time, 40 hours weekly, Monday thru Friday, 8:00am – 5:00pm Travel: 25% t ...
-
Lvn Case Manager Hcat Southlake
2 weeks ago
Optum Southlake, United States**Incentive Bonus 2 times a year** · **18 days of PTO & Closed on Major Holidays** · **401K Match** · **Opportunities at WellMed,** part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who sh ...
-
LVN or RN
7 hours ago
California Job Shop Dallas, United StatesJob Opening: LVN or RN with excellent phlebotomy skills · Location: Dallas, TX · Schedule: Part-Time or Full-Time shifts available. · Part-Time must be able to work at least 3 shifts per week. · Description: Our Dallas practice is looking for a high functioning, self directed n ...
-
Home Health LVN DFW
2 weeks ago
KidsCare Home Health Dallas, TX, United StatesNurses, we are hiring KidsCare Home Health's private duty nursing services enhance our ability to ensure quality patient care by providing collaboration between our nurses and our therapists. This creates a cohesive and dedicated medical professionals team for the children entrus ...
LVN- In Office - Dallas, TX, United States - Kris Anderson Consulting LLC
Description
About the job LVN- In OfficeThis position is responsible for implementing and coordinating all utilization management functions relating to pre-certification of outpatient services. The LVN Case Manager in this capacity is responsible for coordinating authorizations and notifications.Provides workflow, direction, organization and monitoring of authorizations/utilization management. Coordinates and tracks authorization files between Authorization Coordinators and Physician reviewer.
Essential Functions and Responsibilities of the Job
