Texas Licensed Utilization Review LVN

Job Summary

To support a growing healthcare team, the remote Texas Licensed Utilization Review LVN will conduct medical reviews, verify benefits, and determine medical necessity for healthcare services requiring authorization, while serving as a liaison with providers and the Grievance and Appeals Department.

Key responsibilities

• Conduct medical reviews and benefit verifications to assess medical necessity for services requiring authorization
• Communicate with healthcare providers to gather necessary information for medical reviews and ensure timely service decisions
• Complete denial letters in compliance with Texas Department of Insurance and CMS requirements, and support quality assurance initiatives

Required qualifications

• Licensed Vocational Nurse with an active Texas RN license or multistate compact RN license
• Over 5 years of utilization review experience in a health plan, ACO, IPA, or provider group
• Knowledge of HMO, PPO, and POS insurance