Texas Licensed Utilization Management LPN

Job Summary

Supporting daily utilization management operations, the full-time Texas Licensed Utilization Management LPN will review authorization requests, ensure compliance with health plan requirements, and maintain documentation accuracy while working remotely.

Key Responsibilities

• Review and process authorization requests, applying medical necessity criteria and evaluating plan benefits
• Ensure accurate documentation within EPIC or similar systems and communicate authorization decisions to providers
• Support high-volume work queues and assist with workflow improvements and departmental goals

Required Qualifications

• Active LVN/LPN license in a Compact State or Texas
• Minimum 2 years of clinical experience, preferably in utilization management or managed care
• Strong knowledge of medical terminology and clinical workflows
• Experience applying medical necessity criteria such as InterQual
• Excellent communication, documentation, and organizational skills