Job Description:

The LPN – Utilization Management, under the supervision of a registered nurse or licensed physician, participates in utilization management and authorization processes in accordance with their scope of practice.



Essential Functions

Provide education to healthcare providers regarding utilization guidelines and requirements.Conduct initial reviews to determine medical appropriateness and communicate decisions to the health benefit plan, in accordance with scope of practice and established guidelines.Obtain necessary clinical documentation from healthcare providers, clinics, or vendors related to requested procedures, services, admissions, continued stays, or discharge plans.Apply nationally recognized clinical criteria to support recommendations for inpatient and outpatient services.Submits referrals as appropriate for members who require case management as relates to utilization of services and criteria as applicable.Adhere to all policies and procedures regarding the handling of confidential and patient-specific information.Respond to incoming calls related to medical services to determine if prior authorization is required.Complete medical necessity reviews and communicate determinations to providers within required timeframes.Escalate cases to a registered nurse (RN) when clinical expertise is needed prior to decision-making or disposition to the next level of review.Operate under the guidance and direction of a registered nurse (RN).

Skills

Utilization ManagementCase ManagementMedical TerminologyCommunicationPatient CareTime ManagementProblem SolvingNursing

Physical Requirements:

Minimum Qualifications

Current Licensed Practical Nurse (LPN) license in the state of practice.Two (2) years of experience in home health, OASIS documentation, or authorization processes.Excellent observation, verbal and written communication skills, critical thinking abilities, and basic math proficiency.

Physical Requirements

Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing, and reading signs, traffic signals, and other vehicles.

Location:

Nevada Central Office

Work City:

Las Vegas

Work State:

Nevada

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience. 

$26.47 - $40.87

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.