Utilization Management LVN (Hybrid)

Position Summary Department: Managed Services. This position will be hybrid in the Dallas, Texas area. Relocation assistance is available. There are 3 open positions for this role. Responsibilities Perform utilization review activities, including precertification, ensuring appropriate level of care and status (Inpatient, Outpatient, Observation) throughout admission. Conduct concurrent reviews and retrospective reviews following guidelines. Delegate initial reviews to UM RN and determine medical necessity of requests by performing first‑level reviews. Ensure efficient process for providing care, ensuring timely and appropriate levels of care for incoming patients. Prepare cases for Physician Advisor for 2nd level review. Work both remotely and in‑office as needed. Key Skills Excellent verbal and written communication skills. Ability to follow chain of command. Highly developed ability to multi‑task and maintain focus. Proactive, can‑do approach and desire to build positive working relationships through collaborative problem‑solving. Self‑motivated and results‑oriented; sound decision making, flexibility, and prioritization skills with minimal supervision. Strong organizational skills. Basic computer skills: Word, Excel, PowerPoint, Outlook; ability to utilize multiple electronic systems and type 50 WPM. Ability to apply appropriate UM criteria. Education, Experience & Training Required: Current licensure as an LVN in the state of California. Minimum of 2 years of case management experience. Knowledge of payer requirements. Preferred: Certified Case Manager or Accredited Case Manager. Experience with Milliman Care Guidelines (MCG). Minimum of 2 years of bedside nursing experience in an acute care setting. #J-18808-Ljbffr A Hiring Company