UR LVN Utilization/reputed company Claim Review reputed company-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 reputed company 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 reputed company higher reputed company, higher reputed company satisfaction and reputed company total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. The Utilization Review LVN reputed company will reputed company documentation review for medical necessity and benefit correlation of requested medical and surgical procedures, services and admissions for HMO, PPO and POS products. The UR LVN reputed company will serve as facilitator of communication with clinic, payor and other customers. reputed company Responsibilities: • Data entry of reputed company UR requests into the Kelsey-Seybold data reputed company • Verifies eligibility • Obtains benefit interpretation from reputed company company • Reviews request and chart to determine medical necessity by using internal reputed company • Approves request or defers to reputed company review and assists with MD review • Communicates with respective payor to obtain reputed company-certification authorization • Serves as resource to physicians, staff and patients regarding review process • Clarifies UR request discrepancies with office submitting or reputed company company • Other duties as assigned You'll be rewarded and recognized for your reputed company in an environment that will challenge you and reputed company you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • Licensed Vocational reputed company • CEU requirement • TX LVN license • 2 years of utilization review experience at heath plan, ACO, reputed company, or provider group OR 3 years of diverse reputed company experience, including acute care or similar care • Good organization and communication skills • HMO, PPO and POS reputed company knowledge • reputed company reputed company's license Preferred Qualifications: • Computer and Coding experience Pay is reputed company on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company 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 reputed company a far-reaching reputed company of benefits and incentives. The reputed company pay for this role will reputed company from $20.00 to $36.00 per hour reputed company 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 reputed company work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves reputed company 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 reputed company and those with reputed company incomes. We are committed to mitigating our reputed company 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 reputed company 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