Utilization Review LPN / Social Worker
Location: Remote - Must have Kentucky License
Job Type: Temp-to-Perm
Pay Rate: $36-38/hr
Job Summary:
A leading managed care organization is seeking a Utilization Review LPN or Social Worker to conduct utilization management (UM) reviews, ensuring appropriate medical services are provided in accordance with department policies and procedures. The ideal candidate will have a Kentucky (KY) licensure as an RN, LPN, or Social Worker and experience in utilization management, medical review, or related fields.
Key Responsibilities:
- Conduct utilization management reviews using the medical management system, following departmental policies and procedures.
- Review medical necessity, appropriateness, and efficiency of healthcare services based on clinical guidelines.
- Collaborate with healthcare providers and members to ensure quality care and appropriate service utilization.
- Communicate effectively with internal teams and external providers regarding authorization decisions.
- Identify and escalate cases requiring additional medical review or intervention.
- Maintain thorough and accurate documentation of all UM activities.
- Ensure compliance with regulatory and accreditation standards.
Requirements:
- Must have an active Kentucky (KY) license as an RN, LPN, or Social Worker.
- Previous experience in utilization management, case management, or medical review preferred.
- Strong understanding of medical terminology, clinical guidelines, and healthcare regulations.
- Excellent communication and decision-making skills.
- Proficiency with electronic medical management systems and documentation.
Work Schedule:
- Flexible schedule between 8:00 AM – 5:30 PM EST (varied shifts available).
- No strict time zone requirements—candidates in other time zones will be accommodated.
Why Join Us?
- Competitive hourly pay with potential for permanent placement.
- Opportunity to work remotely with a flexible schedule.
- Gain experience in a growing healthcare sector with a reputable managed care organization.
If you meet the qualifications and are interested in this opportunity, apply today!