Texas Licensed LVN Utilization Review

Job Summary

A company is looking for an LVN Utilization Review Specialist to conduct medical reviews and benefit verification.

Key Responsibilities

• Conduct medical reviews and benefit verifications to determine medical necessity for healthcare services
• Serve as a liaison for medical and surgical procedure requests and ensure timely service decisions
• Complete denial letters in compliance with regulatory requirements and support quality assurance initiatives

Required Qualifications

• Licensed Vocational Nurse (LVN) with a valid Texas license
• 5+ years of utilization review experience in a health plan, ACO, IPA, or provider group
• Knowledge of HMO, PPO, and POS insurance
• CEU requirements must be maintained
• Valid driver's license