Utilization Review LVN/RN

• Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Conducts prior authorization reviews to determine financial responsibility

• 2 years Inpatient background with Hospital Nursing (Med-Surg, ER)
• Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review 
• Provider Claims, Appeals and Denials - certain services require prior authorization (PA) from the Utilization Management (UM) department
• 6 + months of Interqual experience
• 6+ months of Coding with ICD10 and CPT/ HCPCS

Interested in being considered? 

If you are interested in applying to this position, please click the Green I’m Interested Button to email your resume and contact Jeff St Louis 407-478-0332x223.