Texas Licensed Utilization Management LVN

Job Summary

A company is looking for a Utilization Management LVN (Remote, Texas-based).

Key Responsibilities

• Coordinate and manage prior authorization workflows with the Utilization Management team
• Review clinical documentation and verify CPT codes for prior authorization requirements
• Support high-need members through ongoing communication and care coordination

Required Qualifications, Training, and Education

• Current, unrestricted LVN license
• Minimum of 2-3 years of clinical experience; prior Utilization Management or Case Management experience preferred
• Knowledge of Texas social service programs and familiarity with NCQA processes preferred
• Understanding of CPT codes and prior authorization requirements
• Proficiency in Google Workspace, EHR systems, and electronic UM platforms