Remote LPN/LVN Utilization Management Reviewer - Employelevate
Join our team at Sagility, a leading healthcare company that combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise. We are seeking a talented LPN/LVN Utilization Management Reviewer to join our team in a fully remote, work-from-home role. As a Utilization Management Reviewer, you will play a key role in ensuring that our clients receive the highest quality care while meeting CMS compliance standards.
In this exciting role, you will be responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities under the provisions of our client's benefits plan. You will conduct timely clinical decision reviews, apply established criteria, and employ your clinical expertise to interpret clinical criteria and determine medical necessity. You will also communicate results of reviews to primary care teams, specialty providers, vendors, and members, and provide decision-making guidance to clinical teams as needed.
We offer a competitive salary and a comprehensive benefits package, including medical, dental, vision, life insurance, short-term and long-term disability, flexible spending account, life assistance program, 401K with employer contribution, PTO, and sick time. If you are a motivated and experienced LPN/LVN with a strong skillset in utilization management, we encourage you to apply for this exciting opportunity.
Key Responsibilities:
Conduct timely clinical decision reviews for services requiring prior authorization
Apply established criteria and employ clinical expertise to determine medical necessity
Communicate results of reviews to primary care teams, specialty providers, vendors, and members
Provide decision-making guidance to clinical teams as needed
Work closely with clinicians, medical staff, and peer reviewers to facilitate escalated reviews
Ensure accurate documentation of clinical decisions and consistency in applying policy
Requirements:
Associate degree and current, valid Massachusetts clinical license in good standing
3+ years combined clinical and utilization management experience
Strong plus: 3+ years experience working in a health plan and/or experience with a care management platform
Ability to apply predetermined criteria to service decision requests to assess medical necessity
Flexibility and understanding of individualized care plans
Strong interpersonal, verbal, and written communication skills
Ability to work independently and in a team-based environment
What We Offer:
Competitive salary
Comprehensive benefits package, including medical, dental, vision, life insurance, and more
401K with employer contribution
PTO and sick time
Tuition reimbursement
Opportunity to work with a leading healthcare company
How to Apply:
To apply for this exciting opportunity, please click on the "" button. We look forward to talking with you!
Sagility is an Equal Opportunity Employer/Vet/Disability.
Apply Now
Apply Now
In this exciting role, you will be responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities under the provisions of our client's benefits plan. You will conduct timely clinical decision reviews, apply established criteria, and employ your clinical expertise to interpret clinical criteria and determine medical necessity. You will also communicate results of reviews to primary care teams, specialty providers, vendors, and members, and provide decision-making guidance to clinical teams as needed.
We offer a competitive salary and a comprehensive benefits package, including medical, dental, vision, life insurance, short-term and long-term disability, flexible spending account, life assistance program, 401K with employer contribution, PTO, and sick time. If you are a motivated and experienced LPN/LVN with a strong skillset in utilization management, we encourage you to apply for this exciting opportunity.
Key Responsibilities:
Conduct timely clinical decision reviews for services requiring prior authorization
Apply established criteria and employ clinical expertise to determine medical necessity
Communicate results of reviews to primary care teams, specialty providers, vendors, and members
Provide decision-making guidance to clinical teams as needed
Work closely with clinicians, medical staff, and peer reviewers to facilitate escalated reviews
Ensure accurate documentation of clinical decisions and consistency in applying policy
Requirements:
Associate degree and current, valid Massachusetts clinical license in good standing
3+ years combined clinical and utilization management experience
Strong plus: 3+ years experience working in a health plan and/or experience with a care management platform
Ability to apply predetermined criteria to service decision requests to assess medical necessity
Flexibility and understanding of individualized care plans
Strong interpersonal, verbal, and written communication skills
Ability to work independently and in a team-based environment
What We Offer:
Competitive salary
Comprehensive benefits package, including medical, dental, vision, life insurance, and more
401K with employer contribution
PTO and sick time
Tuition reimbursement
Opportunity to work with a leading healthcare company
How to Apply:
To apply for this exciting opportunity, please click on the "" button. We look forward to talking with you!
Sagility is an Equal Opportunity Employer/Vet/Disability.
Apply Now
Apply Now