Utilization Management LVN in Dallas, Texas at TEXASCONNECT INC

Department: Managed Services

This position will be hybrid in the Dallas, Texas area.

Relocation assistance is available.

There are 3 open positions for this role.

The Utilization Management (UM) LVN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs concurrent reviews/retrospective reviews according to guidelines. In addition, the UM LVN delegates to UM RN initial reviews and determines the medical necessity of requests by performing first level reviews. The UM LVN ensures a process that is efficient for providing care, ensuring timely and appropriate levels of care for the incoming patients. UM LVN is responsible for preparing cases for Physician Advisor for 2nd level review. This position will be hybrid with remote and in-office assignment.

SPECIFIC SKILLS NEEDED

• Excellent verbal and written communication skills
• Ability to follow chain of command
• Highly developed ability to multi-task and maintain focus
• Proactive, can-do approach and desire to build positive working relationships through collaborative
problem-solving
• Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility
and prioritization skills with minimal supervision.
• Strong organizational skills
• Basic computer skills: Word, Excel, PowerPoint, Outlook. Able to utilize multiple electronic systems.
Type 50 WPM
• Ability to apply appropriate UM criteria

EDUCATION/EXPERIENCE/TRAINING
Required:
• Current licensure as a LVN in the state of California.
• A minimum of 2 years of case management experience.
• Knowledge of payer requirements.

Preferred:
• Certified Case Manager or Accredited Case Manager
• Experience with Milliman Care Guidelines (MCG)
• A minimum of 2 years of bedside nursing experience in an acute care setting