What are the responsibilities and job description for the LPN-Utilization Review position at Viva Health?
Seeking LPNs!
VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, has an opportunity for an LPN-Utilization Review Nurse to join our team!
VIVA HEALTH is the first and only Alabama-based plan to be named an overall 5-out-of-5 Star Medicare Advantage Plan. Our employees are a part of the communities they serve and proudly partner with members on their health care journeys. It's a great time to join our team!
The LPN-Utilization Review Nurse is responsible for answering phone calls and responding to faxed requests from providers for services that require prior authorization. The Utilization Review Nurse reviews requests for medical necessity using evidenced-based criteria or internal guidelines while maintaining compliance with departmental and federal regulations. This position has work-from-home opportunities but requires occasional on-site work.
REQUIRED:
- High school Diploma or GED
- Current LPN license in good standing with the State of Alabama Board of Nursing
- Licensed Practical Nurse certification
- One to three years of experience as an LPN in a hospital setting, private physician, or ancillary vendor's office
- Ability to research, read, and interpret health plans or governmental contracts and medical policy guidelines
- Demonstrate excellent customer service skills through written and verbal communication
- Ability to meet strict deadlines and turnaround times
- Basic computer and data entry skills
- Ability to work during the core hours of operation (8:00 am to 5:00 pm Monday through Friday) and overtime as needed
- Willingness to work in a high volume call center environment
PREFERRED:
- Utilization review or precertification experience utilizing InterQual or Milliman guidelines
- Relevant customer service or call center experience
- Phone Queue Experience
