Utilization Management LVN at WelbeHealth

Los Angeles, California, United States -

Full Time

Start Date

Immediate

Expiry Date

11 Mar, 26

Salary

47.36

Posted On

11 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Chart Auditing, Utilization Management, Medicare Regulations, Medicaid Regulations, Medical Necessity Review, Authorization Requests, Clinical Documentation, Care Plans

Industry

Hospitals and Health Care

Description

Utilization Management LVN 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 clinical expertise in meaningful 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 insurancecoverage (Medical, Dental, Vision) starting day one of employment Work/life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time Advancement opportunities - We’ve got a track record ofhiring and promoting from within, meaning you can create your own path! And additional benefits Salary/Wage base range for this role is $35.87 - $47.36 hourly+ Bonus + Equity. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications. Compensation $35.87—$47.36 USD COVID-19 Vaccination Policy At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations. Our Commitment to Diversity, Equity and Inclusion At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law. Beware of Scams Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to fraud.report@welbehealth.com

Responsibilities

The Utilization Management LVN is responsible for reviewing and auditing authorization requests to ensure compliance with medical guidelines. This includes chart audits, overseeing departmental inboxes, and reviewing prior authorization requests for medical necessity.